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OnitJersitp of Bout Carolina
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Published b^ TAZ. ^^KJA Qf^Lm^ STATE- D<?ARD s^AOMJn
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Entered as secovd-dass matter at Postoffice at Raleigh, N. C, under Act of July 16, lS9i.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 52 JANUARY, 1937 No. 1
STATE CAPITOL AT RALEIGH
The State Capitol is considered one of tlie most beautiful buildings in North
Carolina. In this building the Governor and other State officials have their
offices. In it also the General Assembly meets in biennial sessions to enact laws
and make appropriations to run the State Government.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
a D. Craiq, M.D.. President _ Winston-Salem
J. N. Johnson, D.D.S., Vice-President Goldaboro
G. G. Dixon, M.D...._ Ayden
H. Leb Large, M.D _ _. - Jlocky Mount
H. G. Baity, ScD — Chapel HiU
W. T. Rainby, M.D _ FayetUviUe
Hubert B. Haywood, M.D „ _ Raleigh
James P. Stowb, Ph.G CharlotU
J. LaBbucb Ward. M.D _ _ Asheville
Executive Staflf
Carl V. Reynolds, M.D., Secretary and State Health Officer.
G. M. Cooper, M.D., Assistant State Health Officer and Director Division
of Preventive Medicine.
Warren H. Booker, C.E., Director Division of Sanitary Engineering.
Ernest A. Branch, D.D.S., Director Division of Oral Hygiene.
John H. Hamilton, M.D., Director Division of Laboratories.
J. C. Knox, M.D., Epidemiologist.
R. T. Stimson, M.D., Director Division of Vital Statistics.
R. E. Fox, M.D., Director Division of County Health Work.
H. F. Easom, M.D., Director Division Industrial Hygiene.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin,
which will be sent free to any citizen requesting it. The Board also has
available for distribution without charge special literature on the follow-ing
subjects. Ask for any in which you may be interested.
Adenoids and Tonsils German Measles Scarlet Fever
Cancer Health Education Smallpox
Constipation Hookworm Disease Teeth
Chickenpox Infantile Paralysis Tuberculosis
Diabetes Influenza Tuberculosis Placards
Diphtheria Malaria Typhoid Fever
Don't Spit Placards Measles Typhoid Placards
Eyes Pellagra Venereal Diseases
Flies Residential Sewage Water Supplies
Fly Placards Disposal Plants Whooping Cough
Sanitary Privies
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent
free to any citizen of the State on request to the State Board of Health,
Raleigh, N. C.
Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under B months :
Prenatal Letters (series of nine 5 to 6 months : 7, 8, and 9 months : 10.
monthly letters) 11. and 12 months: 1 year to 19 months;
Minimum Standards of Prenatal Care 19 months to 2 years.
Breast Feeding Diet List : 9 to 12 months : 12 to 16
Infant Care. The Prevention of months ; 15 to 24 months ; 2 to S
Infantile Diarrhea years ; 3 to 6 years. „,,_,
Table of Heights and Weights Instructions for North Carolina Midwlves
CONTENTS
page
1937 In Retrospect and Prospect 3
This is Pneumonia's Busy Season - 4
Our Immediate Task—Take the Tragedy Out of Childbirth 6
Comments on the Engineering Phase of Industrial Hygiene Activities 7
Making Women Mind-Health Conscious 10
Food Poisoning 13
Increase in Cow Population and Milk Production...„ 14
Caution Against Misuse of Common Headache Remedies - 16
V^ol. 52 JANUARY, 1937 No. 1
19 3 7
In Retrospect and Prospect
JUST sixty years ago this month,
the bill to enact a law creating
the State Board of Health was
introduced in the Legislature of 1877
then in session. The measure, much
amended and changed from its origi-nal
form, was finally enacted into law
on February 12, 1877. The appropria-tion
made by the Legislature for the
inauguration of the work was $100.00
a year. The Medical Society of the
State of North Carolina was designated
as the State Board of Health.
At that time the State was hardly
out from under the oppi-essive heel of
the conquering North. Only three years
before fhe last Federal soldier had
been removed from Raleigh. Many of
the people were in extreme poverty.
There was much preventive illness,
such diseases as typhoid fever, malaria,
smallpox, and the bowel diseases of
infants were prevalent in practically
every section of the State.
Dr. Thomas F. Wood of Wilmington
was the leading spirit in the movement
creating the Board of Health. The
Medical Society of the State later
designated him as the first Secretary,
or State Health Officer. Naturally the
<J ajipropriation of $100.00 a year was
C hardly sutHcient to pay the postage on
T the necessary correspondence. Dr. Wood
^ conducted the office from his home in
^ Wilmington where he was editor and
publisher of a successful Medical
Journal.
In 1878 he published the first edu-cational
pamphlet on a health subject
ever published by the State Board of
Health. The title was "Timely Aid for
the Drowned and Suffocated." This was
in the summer months. There were few
bridges across the streams of the State.
In freshets which were common, many
of these flimsy structures were de-stroyed.
All physicians traveled on
horseback for the greater part of the
year. Saddlebags in which to carry
their medicine was the most important
part of the physicians' equipment.
Death by drowning was, therefore, very
common in undertaking to cross these
swollen streams.
By the time the Legislature of 1879
met, it was seen that the plan of hav-ing
the State Medical Society to act as
the State Board of Health was not
practical and, therefore, an amendment
to the law creating a Board of Health
very similar to the present set-up was
enacted. The appropriation was in-creased
from $100.00 to $200.00 a year,
at which figure it remained until the
General Assembly of 1885 increased it
to $2,000 a year.
Dr. S. S. Satchwell of Pender County
was the first President of the Board
of Health, During 1879, following the
amendment to the law, several edu-cational
pamphlets were issued. One of
these was entitled "Limitations and
Prevention of Diphtheria." This was
long before the discovery of diphtheria
The Health Bulletin January, 1937
anti-toxiu, and the disease was more
than horrible to contemplate. Physi-cians
had no effective treatment avail-able
and nnmbers of children died an-nnally
from it. It is significant to
point out here that while diphtheria
anti-toxin has been available to physi-cians
now for about forty years, and
for some fifteen years a preventive
treatment has been available, yet the
State Board of Health during the past
fall has been more concerned with the
prevalence of diphtheria in the State
than with any other problem.
Throughout all the vicissitudes of
the past sixty years, the State Board
of Health, however, has maintained its
chief objective and that is the preven-tion
of the spread of communicable
diseases and the promotion of better
health for all the people. The result of
the work done in the field of preven-tive
medicine and public health during
these sixty years stands out as one of
the most important contributions to
civilization. The span of life has been
increased during that time more than
twenty-five years. This has been largely
accomplished through the control of
epidemic diseases such as bubonic
plague, malaria fever, typhoid fever,
and smallpox, and particularly through
the prevention and control of the fatal
diseases of childhood.
This new year finds a State Board of
Health grown to maturity in many re-spects.
An organization proud of its
past history, but fully conscious of its
responsibility to the future needs of the
people. At present there is some form
of whole time health department serv-ice
in operation in seventy-one coun-ties.
Among the remaining twenty-nine
counties, however, there are eight or
ten counties with large ix)pulation and
much wealth whose people are but little
better acquainted with the manifold
advantages of a modern local health
department than were the people of
sixty years ago. One chief effort of the
State Board of Health this year is to
try to establish an organized health
department in all such counties. An-other
goal to be striven for this year
is the extension of prenatal, obstetrical,
and pediatric service into every county,
available to the poorest of the popula-tion.
The communicable diseases must be
brought under better control, and a
safe water and milk supply together
with modern sewage disposal must be
extended far beyond where the pave-ment
ends in all the cities, towns and
villages of the State.
Verily, there is plenty of work to be
done.
This Is Pneumonia's Busy Season
By Thomas Clarkson Worth, M.D., N. C. State Board of Health
WITH the onset of cold weather
and the beginning of the New
Year, it's time to turn our atten-tion
again to a swift and powerful
enemy, pneumonia. From now until late
February or middle March, judging
from past years, the number of cases
of lobar pneumonia will steadily in-crease
to its peak, then decline again,
at first sharply, until August which
usually has the lowest incidence of any
month. Strangely, the number of deaths
from pneumonia remains about the
same from year to year, except during
epidemics of influenza or other severe
respiratory infections. More cases oc-cur
in the very young and very old,
when resistance is lowest; more males
than females are affected; more
negroes than whites. However, the
January. 1937 The Health Bulletin
most robust may succumb, and in no
one does a permanent immunity or
resistance develop.
In 1914, pneumonia was second
among the causes of death in North
Carolina, whereas in 1934, it was
fourth ; but the number of deaths due
to this disease has remained about the
same. Our methods of prevention and
treatment have had but little effect on
the death rate of this disease.
Pneumonia, sometimes called Lung
Fever or Inflammation of the Lung, is
not one disease, but a group. Usually,
it is caused by an organism or germ,
the pneumococcus, which is small,
round, and occurs in pairs, but a cer-tain
percentage of cases are caused by
other organisms, notably the strepto-coccus
and a rare bacillus.
We shall speak here only of lobar
pneumonia, which can be one of the
most rapidly fatal of all infectious dis-eases.
The pneumococcus causes 95%
of these cases, large areas of the lung
may rapidly become solid, and remain
so for a variable time. When recovery
occurs the temperature usually drops
suddenly—the well-known "crisis."
Though pneumococci look alike, some
of them differ. Thirty-two distinct
kinds or types of them are known at
present. Types 1 and 2 account for
about 60% of the cases of lobar pneu-monia,
type 3 about 10%, and the re-maining
types, 30%. What good does
it do to determine these types? First,
use of an anti-pneumococcus serum
when type 1 or 2 are present has
proven beneficial, although it is at-tended
with some danger which we
shall not attempt to discuss. This serum
must be used early to be of any value
;
best given within three days after be-ginning
of the disease. Second, your
doctor can know much more about how
the case will turn out if he finds the
type of the particular pneumococcus.
Rarely, one may find dangerous
pneumococci in a normal person's
throat ; harmless ones are frequently
found. A "carrier" may harbor danger-ous
pneumococci in his throat for as
long as three months, but he is not
likely to transmit the disease to a
second person unless the latter has a
cold. Similarly, a person with lobar
pneumonia does not readily spread his
infection to another unless the second
person has a cold. One writer* states
:
"Virulent types of pneumococci may
occur in the upper respiratory tract as
secondary invaders following an acute
cold. They are most prevalent on the
fifth and seventh day of the cold. Thus
exposure to chilling or indiscretion on
the patient in the course of a cold,
during this invasion period of the pneu-mococcus,
may result in subsequent pul-monary
involvement."
Everyone should recognize the early
signs of lobar pneumonia so that he
may seek early medical attention. He
may notice a headache, a general lan-guor
or weakness, a sudden sensation
of chilliness, increasing cough, rising
temperature, stabbing pain in the side
as he draws in each breath, or per-haps
he notices his sputum is blood-tinged
or rusty. He may begin to
breath more rapidly. When these signs
occur, he should go to bed immediately
and have someone call the doctor. To
secure absolute quiet, adequate nursing
care, laboratory tests and any special
apparatus such as an oxygen tent, the
patient had best be sent to a hospital.
Now from a preventive standpoint,
there are several points we might ob-serve.
Always, but especially during its
busy season, try to avoid excessive
dampness, over-exposure, and fatigue.
Alcohol is thought to lower the bodily
resistance to pneumonia, and should be
avoided when there is over-exposure.
If you have a cold or some infection of
the respiratory system, stay away from
* Smilie : Public Health Administration in the U. 8., p. 101.
The Health Bulletin January, 1937
a case of pneumonia and remain in bed
until you are again well—colds can be
forerunners of fatal lobar pneumonia.
They should not be ignored or belittled.
Wear sensible clothing suited to the
climate. Avoid over-heated houses.
Stay out of irritating dusts, fumes and
excessive smoke. Maintain an adequate
diet. Clear up points of infection such
as bad teeth and tonsils. Keep the feet
warm and dry ; never leave on wet
shoes and stockings. These precautions
are easily taken. They should certainly
be heeded during the "busy season."
Our Immediate Task—Take the Tragedy
Out of Childbirth
By Mrs. J. Henby Highsmith
AT the beginning of this new year
one thing is clear : Tragedy
should be taken out of childbirth.
Motherhood, which is a woman's most
fundamentally significant experience in
life should not entail the risk of death
and invalidism that It does today for
some classes of women. It should be
made safe. It should be rid of fear,
gloom and dread. Every woman should
know wherein lies the means of safety
concerning this, her most critical
period.
It is the boast of science that it now
knows how to combat death in connec-tion
with childbirth. Then, for the sake
of the mothers who do the dying, and
for the good of maintaining the nation,
why not try to prevent the most tra§;ic
of all deaths, the death of mothers in
childbirth?
More women die between the ages of
fifteen and forty-five from diseases in-cident
to pregnancy and childbirth than
from any other cause, except perhaps
tuberculosis, and this in the face of the
fact that many of these deaths are pre-ventable.
In the United States, last
year, more than 15,000 mothers lost
their lives from causes incident to giv-ing
birth to their babies; in North
Carolina more than 500.
But this deplorable situation does not
have to remain so. Some communities
have already demonstrated that the
lives of mothers need not be sacrificed
at childbirth. They have found that
good medical care and an informed
public that will seek that care, are the
keys to the situation. In communities
where doctors, nurses and civic leaders
work together in providing good care
for all who need it, surprisingly few
have been the deaths of mothers at
childbirth. On the other hand, where
ignorance and indifference cause ex-pectant
mothers to delay seeking care
until it is too late, and where there are
no facilities for saving lives, such as
trained obstetricians and nurses, and
well equipped hospitals, mothers con-tinue
to die.
Fortunately, the year 1937 finds a
fair beginning made in North Carolina
in a permanent program to save the
lives of mothers and babies. Already
110 communities in the State, in about
40 counties, are now engaged in main-taining
health centers where pregnant
mothers can come once a month and
seek to learn what constitutes proper
prenatal care. The centers are super-vised
by the public spirited physicians
and obstetricians of the community and
one or more public health nurses. Here
the mothers are given a physical ex-amination
and are advised as to their
physical needs and safe personal care.
Are the mothers being reached
through these centers? During the
month of October, when the work in
most of the centers was just getting
January, 1937 The Health Bulletin
under way, 1236 mothers attended the
clinics. The mothers are interested.
Furthermore, they are cooperative and
grateful for this service.
What is even more significant and en-couraging,
women are taking up this
fight. Club women, parent-teacher
groups and home demonstration clubs
are becoming aroused and are asking
their physicians, county commissioners,
and others responsible for the welfare
of their people to take steps to save the
lives of the mothers of their com-munity.
Club women especially are interested
in an educational program that is in-tended
to reach every woman in the
State with the personal message that
"Early and Adequate Prenatal Care
Will Greatly Reduce the Risks of
Motherhood." They believe that a bet-ter
educated womanhood will soon
come to demand better obstetrical care
for all mothers, as well as more ade-quate
nursing and hospital service.
In their program club women are
urging on the part of every club
:
1. To know the maternal death rate
of its community for over a period of
three years and to compare it with the
State and national average.
2. To know how many of the ma-ternal
deaths were preventable. How
many were due to lack of proper obstet-rical
care. How many due to negligence
on the part of the mothers themselves
or their families.
3. To know what prenatal health
services are available to the mothers
of the community.
4. To study the bearing of the eco-nomic
conditions imder which the
mothers live upon the maternal death
rate.
5. To cooperate with the State and
county boards of health, local physi-cians
and nurses, superintendents of
public welfare, in reaching and caring
for indigent pregnant mothers.
For mothers themselves the club
woman's program stresses the follow-ing
points
:
1. Examination as early as iwssible
during pregnancy by a competent phy-sician.
2. Subsequent visits by expectant
mothers at regular intervals to their
physicians.
3. An aseptic delivery by a compe-tent
doctor.
4. Post partum examination immed-iately
after delivery and about six
weeks later.
5. Adequate post-natal care, includ-ing
medical and nursing service, and
treatment of post partum complica-tions.
Comments On the Engineering Phase
of Industrial Hygiene Activities
By M. F. Trice, Engineer, N. C. State Board of Health
INDUSTRIAL Hygiene activities re-veal
that workers frequently risk
health and even life itself to pro-vide
many of the commodities that are
in use. The products involving such
dangers are diverse. Health hazards,
for example, are associated with the
manufacture of such unrelated mer-chandise
as false teeth, wall paper, the
garden hose, and even the face iwwder
with which the daily ritual is per-formed.
All may have exacted a toll of
health and happiness in their trans-formation
from the crude natural
product to finished material. It is one
of the paradoxes of the ages that some
lives must be sacrificed in order that
others may be lived more comfortably.
8 The Health Bulletin January, 1937
The situation is more tragic than it
need be, for much of the suffering re-sulting
from hazardous occupations
may be mitigated or eliminated al-together
by the use of recently de-veloped
safeguards. By evaluating oc-cupational
disease hazards and en-couraging
the introduction of measures
for the protection of the worker, the
State Board of Health intends to re-duce
the number of lives that are year-ly
placed upon the altar of industry.
The Division of Industrial Hygiene is
the department that is charged with
the task of preventing the annual sacri-fices
to occupational diseases. In the
execution of a program of industrial
preventive medicine the services of
both physicians and engineers are re-quired.
This segregates the work into
medical and engineering activities, and
since the scope of both covers many
ramifications, it is wise to discuss them
separately. Consequently, this is the
first of two papers that will be pub-lished
in the Health Bulletin on this
phase of health work. This address, as
the first, will present the engineering
phases of the Industrial Hygiene pro-gram.
Later the medical activities will
be presented.
Uiwn the engineer devolves the task
of isolating and appraising the factors
responsible for the condition or condi-tions
that are inimical to the health of
the worker. An investigation of this
kind necessitates the use of knowledge
and tools common to several of the
major branches of engineering. Prob-ably
of major importance is basic
training in chemical engineering since
occupational diseases, in the main, re-sult
from the exposure of the worker
to toxic mists, fumes, gases, mineral
substances, solvents, and other com-pounds
that are used in manufacturing
processes. The extent of the hazard to
which the worker is subjected is quite
often dependent upon the amount of
ventilation available. Involved in this
phase of a study are both the general
atmospheric conditions in the work-room
and the capture, by exhaust ven-tilation,
of noxious substances at the
point of their origin. For such work
tools and knowledge developed by the
mechanical engineer are employed. This
profession also contributes the means
whereby heating and air conditioning
are studied. From the physicist, who
contributes knowledge common to all
of the engineering professions, are ob-tained
the tools and methods employed
for evaluating the illumination of the
workroom or the job.
It is not difficult, perhaps, for the
layman to envisage the effects of chem-icals
and minerals upon the health of
industrial workers. Such substances
are responsible for a variety of ills,
among which are diseases of the skin,
classified as dermatoses ; diseases of
the lungs grouped together as the pneu-moconioses,
and destruction of the red
blood cells, impairment of liver, brain,
and functions of other vital organs
which are identified as degenerative
diseases. Although difficult to appraise,
improper heating and ventilation of
workrooms undoubtedly influence the
death rates for industrial workers,
which compared with those for the
agricultural workers are 297.6% higher
for tuberculosis of the respiratory sys-tem
and 213.1% higher for pneumonia.
That occupational disease hazards are
associated with many occupations is
evidenced by the fact that the life ex-pectancy
of the industrial worker is
seven years less than that for the non-industrial
worker. Improper illumina-tion
is charted in some textbooks as
an occupational disease hazard, since
it promotes sickness, injuries, and
under some conditions may be respons-ible
for degenerative changes in the
eye.
The instruments employed by the
engineer in evaluating workroom haz-ards
are varied. For determining the
concentration of dust in the atmosphere
an impinger flask, small motor blower
January, 1921 The Health Bulletin 9
outfit, aud a microscope are the raajor
devices used. Pitot tubes, anamometers,
Kata tlaermometers and other instru-ments
are employed for determining
air velocities. Wet and dry bulb ther-mometers
reveal the relative humidity
of workrooms ; an illumiuometer meas-ures
the foot candles of light provided,
and there are instruments for measur-ing
the concentration of deadly carbon
monoxide and hydrogen sulphide gases
in the atmosphere. In addition, equip-ment
common to most general chemical
laboratories is essential for a complete
appraisal of occupational disease haz-ards.
A most important function of the
Division is to establish the concentra-tion
of various toxic substances to
which the worker may be exposed with-out
suffering ill effects. While various
investigations have established such
data for many substances, the great
number of processing chemicals in use
and the variety of natural products
that are being handled make of this
phase of the work a vast field of virgin
territory. The concentration of a sub-stance
at which it becomes definitely
toxic or at which it will impair the
health of a worker is termed the
"threshold limit." The establishment of
such limits is possible only by a cor-relation
of engineering and medical
findings. For this reason, there is found
in public health work no greater inter-dependence
of medical and engineering
activities than exists in a Division of
Industrial Hygiene. The establishment
of "threshold limits" should prove of
great value to industry. Usually it is
impracticable to entirely eliminate the
offending substance; however, the con-centration
of it to which the worker
is exposed can be controlled within
certain limits. The establishment of
"threshold limits" will serve as guides
to industry in the control of occupa-tional
disease hazards.
The value of siich work is apparent.
Specifications for equipment to be in-stalled
for the control of such risks
may be written intelligently. This alone
should eliminate the purchase of sys-tems
that may prove to be inadequate
to satisfactorily solve the problem at
hand. In aU instances where original
installations must be abandoned or en-lai-
ged because of failure to measure
up to requirements a waste of money
is involved. In the matter of Work-men's
Compensation Insurance the
premium for occupational disease cov-erage
in an industry may be lowered
as a result of an investigation made to
establish a "threshold limit." Of far
greater importance, however, is the
value accruing to the State and to in-dustry
through the conservation of the
human resource.
North Carolina is rapidly being
transformed from an agricultural
state into an industrial commonwealth.
With the change, there is ushered in
new problems in public health. In order
to keep pace with the changing status
new activities are mandatory. As a
result of the transformation, the Divis-ion
of Industrial Hygiene was organ-ized
more than a year ago to cope with
the new problems that have arisen for
solution.
The object of the Division of Indus-trial
Hygiene, as well as of all public
health agencies, is to make it possible
for everyone to get the most out of
life. This thought is forcefully ex-pressed
in a bit of verse entitled
"Resolve" by Charlotte Perkins Gil-man,
the first three lines of which read
as follows
:
"To keep my health!
To do my work!
To Uve!"
"The economic cost of the common
cold is enormous. It takes more dol-lars
and cents out of the worker's
pocket in salary and out of the em-ployer's
pocket in loss of production
in one year than any other sickness."
10 The Health Bulletin January, 1931
Makins Women Mind-Health Conscious o
By Mrs. John D. Robinson, Wallace, N. C.
MEMBERS of the Woman's Auxil-iary
to the North Carolina State
Medical Society are indebted to
the State Board of Health for granting
us this space in The Health Bulletin
to give you a health message in which
we. as a body, are greatly interested.
For years the Woman's Auxiliary has
felt that as an organized group it
should sponsor some specific phase of
educational health work that would
benefit women particularly. We are
told that today institutions for the
mentally diseased are rapidly being
filled with women suffering from con-ditions
that could have been prevented
had they known what constitutes a
healthful state of mind. In view of this
we have decided that our first message
shall be on the subject of preventing
mental and emotional disturbances
among women, or, making women
mind-health conscious. In- choosing this
subject we hasten to say that we our-selves
are not capable of teaching or
advising regarding this difficult phase
of mental hygiene but feel perhaps
that we can be of assistance to a large
group of women now groping in men-tal
darkness by passing on to them
ideas and suggestions gleaned from
leading psychiatrists and mental hy-gienists
of this country.
It is predicted that the next great
step in preventive medicine will have
to do with the prevention, alleviation
and cure of mental diseases. Many be-lieve
that medical science is now on
the eve of making tremendous gains in
the field of mental hygiene which will
lead to increased human happiness and
decreased consumption of public taxes
through institutional care of mental
patients. Only a few years ago no
medical school taught psychiatry ; now
all Grade A medical schools have re-quired
courses in psychiatry and offer
studies of such problems as personality
defects, the nature of adjustment fail-ures,
problems in child guidance and
the mechanism of personality break-downs.
This is a forward step since the
vast bulk of psychatric treatment is
done, not in state hospitals nor by
privately practicing psychatrists, but
by general practitioners and family
phy.sicians. It is the latter who have
frequent contact with patients having
minor nervous ailments and psycho-logically
produced aches and pains. As
a group, practicing physicians are in a
position to do the most good for this
class of suffering humanity.
Mental ill health is certainly as com-mon
as physical ill health and probably
more so. Cicero said, "The diseases of
the mind are more numerous and more
destructive than those of the body."
He was right, but they are not always
recognized as such. Medical science
has always been ambitious. Its general
effort has been to devise means to
secure for mankind a perfectly health-ful
stomach, heart and all other organs.
It now turns its attention to the brain
and asks to discover means by which
the working mind can be made per-fectly
healthful. The objectives of men-tal
hygiene is successful living. This,
then, is what the newest branch of
medical science aims to accomplish
:
to produce that healthiness of mind
which will enable a man to preserve
his own life and to develop his best
powers of mind and body.
It is heartening that public health
agencies are turning their attention to
this field of preventive medicine and
give hope that mental diseases are
soon to be better understood and means
of their control brought into general
practice. Definite progress has already
been made. What were once thought
of as incurable and hopeless mental
January, 1931 The Health Bulletin 11
states are now known to be curable and
preventable. Many baffling maladies
that used to be thought of as having a
physical basis have been found to be
caused by disordered minds. In recent
years treatment of the Insane has un-dergone
revolutionary changes, and the
public's attitude toward persons suf-fering
with a mental disease has made
it possible for them to seek early and
effective cures.
Dr. Andrew H. Wood, who is direc-tor
of the Iowa State Psychopathic
Hospital and who has done outstand-ing
work in the field of mental hygiene,
says that better mental health is to
be achieved by the same means by
which we now have better physical
health, which is by discovering the
cause of the trouble and then finding
a way to remove it and its effects. He
believes that if people know the dan-gers
of living continuously with upset
emotions, imhappy mental states and
under fears and dread, they can do
much to change or remove these un-healthful
conditions. He names some of
the more common causes of nervous
breakdowns and disturbed mental
states as hurt feelings, undue suspic-iousness,
unhappy social relations in
the home or community, dread of in-feriority,
unwillingness to be oneself,
and the arch-enemy, worry. He says
that the home must be the starting
place where serenity, self-reliance and
sound attitudes toward life are formed
;
where lop-sided personalities are not
allowed to start, and where wholesome
physical and mental patterns of life
are shaped and lived.
According to Dr. Woods, means of
preventing mental ill-health and
wrongly developed personalities should
begin in the home and in the first
years of children's lives. The attitudes
toward life gained by children in their
first four or five years, determine not
only their future careers but also their
mental excellence and their outlook on
life. Good feeling and good sense, he
says, afford the most favorable environ-ment
for the growth of character and
pei'sonality. Homes in which the at-mosphere
is marked by sincerity, af-fection,
courage and industry are con-ducive
to good mental traits and
wholesome behavior.
When the mind is depressed or over
stimulated by painful emotions, the
body cannot function properly. Some-one
has said that such emotions as
excitement, anger, fear and worry are
like strong hypodermic injections of
highly poisonous drugs. They have in-jurious
eft'ects on the body and interfere
with digestion, the secretion of glands,
the action of the heart, circulation,
respiration and all the other functions
of the body.
As a rule, you cannot medicate peo-ple
into a better personality, a better
frame of mind or a better adjustment.
Usually something else is necessary.
The use of drugs, particularly mor-phine
and whisky, is an unsafe way
of escaping reality. It leaves the per-son
less able to face his problems than
ever before.
A person suffering from neurosis
must be encouraged to want to get
well. Many claim that they wish to
get well but balk at the first sugges-tion
for treatment. A crippled beggar
who has earned his living for 20 years
by selling pencils on the street would
be in a terrible plight if suddenly cured
by some miracle. He would have his
legs back, but he would have lost his
livelihood. He really does not want to
be cured. In a similar way many neu-rotic
patients refuse to conform to
treatment.
Fatigue, according to E. Stanley Ab-bott,
has a direct bearing on one's men-tal
health and efficiency. If conditions
which cause excessive fatigue are al-lowed
to persist, the manifest symp-toms,
he says, are likely to develop
into some of the various mental de-pressions
and finally in some cases
into pronounced insanity of some form.
12 The Health Bulletin January, 1937
Why do people get tired, we might
ask. The answer is, of course, because
they do not get enough rest. x\nd why
dou't tliey rest? Sometimes they can-not,
because with small incomes and
large families the work must be done
and perhaps there is no one else to do
it. It may be they have to support
others and sudden business reverses
or misfortunes have befallen them so
that they need must work. But more
often they only think that they cannot
stop to rest. When the actual crisis
comes, and they are forced to stop,
they realize too late that it would have
been easier and much more economical
if they had stopped in time and avoided
a breakdown. Often i^eople deceive
themselves, thinking that they will find
a more convenient time to rest, bvit
they rarely do; or that they can stand
to work a little longer, or as they
have always been well, and such a
thing as a breakdown could never hap-pen
to them.
It is a good thing to work hard and
systematically during regular but
limited hours. It is a crime, however,
against one's life—and in the case of
young women, against the lives of the
next generation—to work or play so as
to be persistently tired. Just where the
fatigue point is varies among indi-viduals,
and often in the same individ-ual
accordingly as he is well or ill fed.
or well or poorly rested.
Other reasons why housekeepers do
not get enough rest are that they hold
to erroneous ideas. Change of occupa-tion
is thought to rest one, but in some
cases it only tires the more, though the
interest of it may hide fatigue.
Our ordinary recreations (they
should be called diversions for they
do not recreate us) are often fatiguing
though the enjoyment at the time hides
the fact. We are apt to attribute the
fatigue we feel after the diversions
wholly to the previous fatigue, when
in reality, part of it is due to the
diversion itself. Everything we do re-quires
energy. We use energy when
we read a book or a newspaper. It
requires energy to listen attentively
to a lecture, to feel responsibility, to
share sorrow or enjoyment.
We cannot avoid getting tired but we
can avoid getting too tired. When tired,
we should do less, that is, expend less
energy per day. When tired, one is
usually less hungry. Some think that
food will not digest if one does not
have an appetite for it. It may take
longer, but it will digest and yield up
its energy.
Another mistaken idea is that if one
is wakeful one should read or take ex-ercise
in order to get tired enough to
sleep. In most cases one is wakeful be-cause
of being too tired to sleep. No
one can expect to benefit by adding to
his fatigue. It is better to lie quietly
in bed. with the eyes closed and wait
for sleep to come, than to expend
energy in an effort to induce sleep.
We are apt to forget that in late
youth and early middle age our body
and mind begin to be less quickly and
completely rested, that we fatigue eas-ier
and it takes longer to be restored
to normal state. Everyone should get
enough rest each night to make up
fully for the wear and tear of the
previous day. A few rare creatures like
Napoleon and Edison can keep going
with 3 or 4 hours sleep out of the 24,
but the vast majority of us would
come to grief if we should try it. The
average person needs at least 8 or 9
hours rest daily.
It has been estimated that about half
the nervous breakdowns could be pre-vented
if every one would
1. Take pains to learn what things
cause fatigue.
2. Would realize that i^ersistence in
the fatiguing process may cause
a breakdown.
3. Would recognize that the cure of
fatigue is rest and food, not more
or different activity.
January, 1937 The Health Bulletin 13
4. Would thiuk that he himself is
not an exception to the rule but
would apply to his own case the
principles that he would apply to
another.
We need also to remember that fa-tigue
is cumulative, that it piles up, or
rather that our reservoir of energy will
slowly become exhausted if we do not
add to daily as much as we use up. It
may take months or years to reduce
the store to the point of a breakdown,
but on the other hand it may take years
to overcome our losses, even if then.
And so as Dr. Karl A. Menninger
says : "Let us define mental health as
the adjustment of human beings to the
world and to each other with a maxi-mum
of effectiveness and happiness.
Not just efficiency, or just contentment,
or the grace of obeying the rules of
the game cheerfully. It is all of these
together. It is the ability to maintain
an even temper, an alert intelligence,
socially considerate behavior, and a
happy disposition. This, I think is a
healthy mind."
Food Poisoning
SIGNIFICANT bacterial contami-nation
of foods falls into two
groups ; contamination with spe-cific
infectious bacteria such as the
typhoid bacillus, and contamination
with bacteria that may bring about
deleterious changes in the food itself.
The contamination of foods with bac-teria
derived from human and from
certain animal infections, such as
tuberculosis and various septic pro-cesses,
is a familiar public health prob-lem.
As regards raw milk, particularly,
in which the possibilities of contami-nation
are numerous and multiplication
of many bacteria can readily occur,
preventive measures, public and pri-vate,
have long been considered neces-sary.
The almost universal practice in
the United States of pasteurizing milk
has greatly reduced the food hazards
of this type. The recent indorsement
by the Certified Milk Producers Asso-ciation
of the pasteurization of certified
milk emphasizes the sanitary value of
the pasteurizing process. Greater
cleanliness in the preparing and serv-ing
of raw foods has likewise dimin-ished
the danger of food-borne infec-tion.
At present the possibility of bacter-ial
contamination of food with specific
pathogens is best dealt with by
thorough cooking, by general measures
of cleanliness, by careful avoidance of
foods derived from sick or unsound ani-mals,
and possibly, in certain limited
groups, by supervision of food handlers.
Routine examination of all food
handlers, although advocated by a few
sanitarians, is a task of almost in-superable
difficulty in the hotels and
restaurants of large cities because of
the frequent turnover of personnel ; as
regards the individual housewife or
domestic servant, it is quite out of the
question.
A well known instance of illness
caused by swallowing harmful sub-stances
formed in foods by bacterial
action is botulism. The high fatality of
botulism (80 per cent or more) makes
this disease justly dreaded in spite of
its relative rarity. The botulism bacilli
are widely distributed in soil and grow
readily in a variety of foodstuffs under
anaerobic conditions such as exist in
foods preserved by heat and some other
methods. Processes for the destruction
of the bacteria of botulism were ac-curately
worked out by commercial
canning organizations in the United
States about ten years ago, and their
general application by the canning in-dustry
has been followed by immediate
practical success.
14 The Health Bulletin January, 1937
Since 1925 there has beeu no instance
of botulism traced to the use of food
commercially canned in the United
States, although there have been two
recent outbreaks of botulism caused by
commercially canned food imported
from other countries, one from im-ported
canned German sprats.
The chief danger from botulism in
this country at present appears to lie
in the use of locally grown and home
canned foods. Although many attempts
have been made by the United States
Department of Agriculture and other
agencies to foster the use of suitable
home canning methods, outbreaks of
botulism traceable to the use of imper-fectly
sterilized home canned foods con-tinue
to occur. In 1935 there were
twenty-three such outbreaks with
sixty-nine cases and forty-two deaths.
K. F. Meyer has succinctly expressed
the situation : "Until every farmer's
wife has been taught that all vegetables
or other nonacid foods home canned
by the boiling water or oven process
must be thoroughly boiled before they
are served, botulism intoxication may
be anticipated."
Another type of food poisoning
caused by the presence in foods of the
products of bacterial action has come
to light in recent years. It has been
established that certain common bac-teria,
when given an opportunity of
growing in foods under suitable condi-tions,
generate a toxic substance that
may cause violent gastro-intestinal
symptoms. It has, for example, been
definitely shown that staphylococci are
able to produce a substance that is
iwisonous when swallowed by man and
by the monkey. This type of food ix)i-soning
has been most commonly ob-served
in hot weather in connection
with the use of cream-filled pastries.
Several outbreaks have been traced to
cream pies, chocolate eclairs and
similar pastries, the number of vic-tims
in a particular outbreak some-times
mounting into the hundreds. Al-though
the symptoms produced by this
toxic substance are sometimes severe,
the attacks are rarely, if ever, fatal.
Cleanliness of the ingredients and
proper attention to the sanitation of
the environment and of the personnel
engaged in manufacture constitute an
important safeguard against this form
of food poisoning, since heavy initial
seeding is doubtless one of the factors
leading to abundant production of the
toxic substance. Prompt and constant
refrigeration is also an important aid
in preventing bacterial multiplication.
In some localities oflBcial restrictions
have been placed on the sale of cream-filled
bakery goods in hot weather.
—
Journal, American Medical Association.
Increase In Cow Population And
Milk Production
By Guy A. Cardwell, Agricultural and Industrial Agent,
Atlantic Coast Line Railroad Company
THE editor of The Health Bulle-tin,
published by the North Caro-lina
State Board of Health, Octo-ber
1936 issue, says that for several
years he has been bemoaning the fact
that Eastern North Carolina as a whole
had not developed its dairy industry.
"As late as three years ago, on a
trip of 100 miles east of Raleigh, the
editor was able to see from the public
highway, going and coming, only one
lone milk cow, with the exception of a
dairy herd near one of the larger
towns."
January, 1937 The Health Bulletin 16
On a recent visit wliicli took the edi-tor
through twenty-five Eastern Coun-ties
he fountl a very different situation
as described in the following words
:
"The east has certainly aroused it-self,
and while there may be some
places throughout the section where
there is still a scarcity of cows, such
places are becoming fewer and smaller.
A fine illustration denoting the radical
change in sentiment throughout the
east may be noted in a story told the
editor a few days ago.
"A State official who had visited the
manager of the Caledonia Prison Farm
in Halifax County informed the editor
that on an official visit to that farm he
was discussing with the manager the
problems of milk supply, dairy regu-lations,
etc. The prison farm manager
told him that he did not want anything
to happen to lessen the supply of milk.
The manager said : 'We get the prison-ers
who are not in good health, who
have bad teeth, and who are otherwise
below par and do not make good road
workers,' etc. He said 'I have found
that by giving these men milk in abund-ance
as soon as they arrive, that within
a few weeks on such a diet, with the
necessary vegetables and other acces-sories
to the milk diet, they improve in
health and weight and make good
workers.' This man found out for him-self
what nutritionists and health of-ficials,
physicians, and agriculturalists
have found for themselves and have
known for a long time. It is to be
hoped that the Eastern section of the
State will develop its commercial dairy
interest as well as provide for an
abundance of dairy products for every
family in the section."
County farm agents, vocational agri-cultural
teachers, agricultural journals,
and agricultural leaders in general in
both of the Carolinas have featured
livestock in their programs for the
past several years, and their work has
produced results as any observing per-son
familiar with old conditions can
readily determine in traveling about
the Carolinas.
According to the Farm Census, 1935,
milk production on North Carolina
farms in 1934 totaled 138,000,000 gal-lons,
and the number of cows milked
increased from 268,373 in 1929 to 352,-
782 in 1934.
The trip made by the editor of The
Health Bulletin one hundred miles
east of Raleigh may have embraced
parts of Johnston, Nash, Wilson, Edge-combe,
Martin, Pitt and Beaufort Coun-ties.
It may, therefore, interest him to
note that in these counties the in-crease
in the number of cows milked
in 1934 over 1929 is 70 per cent. The
total number of cows milked in these
counties in 1929 was 9,557 and in 1934
the total number of cows milked was
16,223. Farms reporting cows milked
in 1929 numbered 6,934, and farms re-porting
cows milked in 1934 numbered
11.926.
There has not only been a substan-tial
increase in the cow population,
but the improvement of individual ani-mals
is most marked. In addition to
the increase in dairy animals there has
been a smaller increase in beef ani-mals,
and a decided improvement in
hogs and poultry.
FOR THE NAMES CLUB
A friend waiting in the office of
Dr. Carr, Duplin County Health Of-ficer,
the other day was handed a note
as it came in to Dr. Carr from Mrs.
Harvey Boney, County Welfare Of-ficer.
Here is what was in the note:
"Dear Dr. Carr:
"Mrs , who lives in Purgatory
over near Hell's Swamp is calling for
a doctor for her husband."
This reminded a girl in the office
that when she lived in Florida there
was a firm of undertakers and em-balmers
on West Beaver Street in
Jacksonville by the name of Geter and
Baker.
16 The Hkaltii Bulletin January, 1937
Caution Against Misuse of Common
Headache Remedies
By Thomas C. Worth, M.D.
RECENT inquiry lias readied us
from a large industrial organiza-tion
in North Carolina requesting
information and advice concerning tlie
danger of two highly advertised head-ache
remedies. Since they were being
sold in the canteen of the mill, these
industrialists had heard of the dangers
of these drugs and were anxious for
the safety of their employees. Such
progressive and thoughtful action as
this has encouraged us to re-emphasize
the misuse of common headache reme-dies.
In the constant radio and press
"bally-hoo" concerning the remarkable
relief of simple inorganic aches and
pains, the promoters of these drugs
are always careful not to mention a
few pertinent facts, all of you ought
to know. That's the trouble with their
advertising, they tell you only part-truths
and withhold whatever they
want to keep from you.
These headache powders contain cer-tain
of the coal-tar derivatives, whose
action, in addition to allaying simple
headaches, is one of depression of the
heart, especially when taken in exces-sive
doses. This action occurs directly
on the heart muscle itself. In addition,
some individuals, following excessive
doses of these powders, have a great
many of their red blood corpuscles
destroyed, with the formation of a sub-stance
in their blood-stream called
Methemoglobin (meth"em-o-glo'bin )
.
This gives a blue color especially to
the lips and ears, but sometimes to
the entire body, a state called cyanosis.
Now, the most important point to
remember is that when a person has an
idiosyncracy (id"-e-o-sin'kra-se) to one
of these drugs, (which simply means
he is sensitive to this drug) as small
a dose of the headache powder as will
go on the tip of a knife blade will
produce this blueness (cyanosis) de-pression
of the heart, low body tem-perature,
severe sweating, and even
death. The dangers of such a drug are
obvious.
Such remedies are useful and help-ful
when taken under careful medical
supervision, and most risky and dan-gerous
when taken promiscuously.
Others than millworkers need pro-tection
against this nuisance, for some
users of these dangerous remedies
come from the wealthier and better
educated classes of people. They simply
need full information.
We will let the following item from
the Fayettemlle Observer illustrate our
point
:
"Word comes from High Point of
the death of Miss soon
after taking a remedy for a headache.
This news following close on the heels
of a similar occurrence in Lumberton
possibly is just a coincidence, but
enough of a coincidence we think to
suggest the necessity of an investiga-tion
to determine if the same brand of
headache remedy was used in each
fatal instance."
Plans for the first National Social
Hygiene Day, to be held February 3,
1937, are announced by the American
Social Hygiene Association, of 50 West
Fiftieth Street, New York City. On
this day, state and community volun-tary
organizations interested in the
control of syphilis and gonorrhea and
other social hygiene problems, with
the advice and approval of health
authorities and the medical and allied
professions, are planning to hold meet-ings
all over tlie United States.
Piibli5\edbw TFdLN^KXnOP^hmiK STATE- B«?ARDs^AO\Lin
Thi5 £)u]1elir\willbe Jer\t free to qimj citizen of the 5taleupor\ request!
Entered a.s second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, lS9i.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 52 FEBRUARY, 1937 No. 2
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—^ DREAMS ^
By Dr. Milton J. Rosenatj
"Preventive medicine dreams of a time when there shall be
enough for all, and every man shall bear his share of labor in
accordance with his ability, and every man shall possess suf-ficient
for the needs of his body and the demands of health.
These things he shall have as a matter of justice and not of
charity.
"Preventive medicine dreams of a time when there shall
be no unnecessary suffering, and no premature deaths ; when
the welfare of the people shall be our highest concern; when
humanity and mercy shall replace greed and selfishness; and
it dreams that all these things will be accomplished through
the wisdom of man.
"Preventive medicine dreams of these things, not with the
hope that we, individually, may participate in them, but with
the joy that we may aid in their coming, to those who shall
live after us.
"When young men have vision the dreams of old men
come true."
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MEMBERS OP THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. Ckaio. M.D., President - Winston-Salem
J. N. Johnson, D.D.S.. Vice-President Goldsboro
G. G. Dixon, M.D Ayden
H. Lee Large, M.D Jlocky Mount
H. G. Baity, ScD _Chapel Hill
W. T. Rainey, M.D Fayetteville
Hubert B. Haywood, M.D A"?*, f.
James P. Stowe, Ph.G Charlotte
J. LaBruce Ward, M.D Asheville
Executive Staff
Carl V. Reynolds, M.D., Secretary and State Health Officer.
G. M. Cooper, M.D.. Assistant State Health Officer and Director Division
of Health Education. Crippled Children's Work, and Maternal
and Child Health Service.
Warren H. Booker, C.E., Director Division of Sanitary Engineering
and Malaria Control.
Ernest A. Branch, D.D.S., Director Division of Oral Hygiene.
John H. Hamilton, M.D., Director Division of Laboratories.
J. C. Knox, M.D., Director Division of Epidemiology and Venereal
Disease Control.
R. T. Stimson, M.D., Director Division of Vital Statistics.
R. E. Fox, M.D., Director Division of County Health Work.
H. F. Easom, M.D., Director Division Industrial Hygiene.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly
which will be sent free to any citizen requesting
available for distribution without charge special
ing subjects. Ask for any in which you may be
Adenoids and Tonsils
Cancer
Constipation
Chickenpox
Diabetes
Diphtheria
Don't Spit Placards
Eyes
Flies
Fly Placards
German Measles
Health Education
Hookviform Disease
Infantile Paralysis
Influenza
Malaria
Measles
Pellagra
Residential Sewage
Disposal Plants
Sanitary Privies
The Health Bulletin,
it. The Board also has
literature on the foUow-interested.
Scarlet Fever
Smallpox
Teeth
Tuberculosis
Tuberculosis Placards
Typhoid Fever
Typhoid Placards
Venereal Diseases
Water Supplies
Whooping Cough
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent
free to any citizen of the State on request to the State Board of Health,
Raleigh, N. C.
Prenatal Care (by Mrs. Max West)
Prenatal Letters (series of nine
monthly letters)
Minimum Standards of Prenatal Care
Breast Feeding
Infant Care. The Prevention of
Infantile Diarrhea
Table of Heights and Weights
Baby's Daily Time Cards : Under 5 months ;
5 to 6 months ; 7. 8, and 9 months ; 10
11, and 12 months ; 1 year to 19 months
19 months to 2 years.
Diet List : 9 to 12 months ; 12 to 15
months ; 15 to 24 months ; 2 to 3
years ; 3 to 6 years.
Instructions for North Carolina Midwives.
CONTENTS
Page
Notes and Comment ^
Progress in Maternal and Child Health Work 5
Brief Notes on Bronchiectasis 9
Maternal and Child Health Work in Charlotte, N. C —• H
Endemic Typhus in North Carolina - 14
I PUBLISAELD BY TML nOR.T/A CAgOLIhA 5TATL BOA^D s^MLALTM |
Vol. 52 FEBRUARY, 1937 No. 2
Notes and Comment
By The Editob
ELSEWHERE in this issue we are
publishing an article by the Edi-tor
of The Hf.at.th Bulletin, who
is also Director of the Division of Ma-ternal
and Child Health Service of the
State Board of Health. This article
sets forth briefly a synopsis of the
efforts that have been made the past
year, in co-operation with the United
States Children's Bureau and the dif-ferent
counties participating in the ef-forts.
It will be seen by reading the
article that probably greater progress
has been made looking toward the
establishment of permanent measures
which will eventually make North
Carolina as safe as any other state for
mothers of the childbearing age and
for infants than has been made hith-erto.
It will be seen that at the close
of the year about 117 different locali-ties
were co-operating with this de-partment
in extending prenatal medical
service to indigent women, as well as
to advising on infant care. This work
extended to a total of forty counties.
In addition to the article by the
Editor, we are also publishing a con-tribution
by Dr. W. Z. Bradford, an
obstetrician of Charlotte. Dr. Brad-ford
describes in detail the efforts
made in the City of Charlotte during
the last few years to afford not only
prenatal medical service, but medical
service at confinement to indigent
women in the City of Charlotte and
its environs. This work has been
made possible, as will be seen by read-ing
the article, through the co-ordi-nating
facilities of the Charlotte and
Mecklenburg County Health Depart-ments
and the various civic organiza-tions,
all of which is described by Dr.
Bradford. The most significant con-tribution
which has been made to the
Charlotte work has been done by the
Duke Medical School. The young in-ternes
from that institution have
made possible free medical service of
the highest type to a large group of
indigent people in Charlotte. This
arrangement has filled the gap which
is acutely felt in all our work in other
sections of the State.
JUST before the end of the year our
friend, Dr. R. L. Carlton, City Health
Ofl5cer of Winston- Salem, sent the
Editor a clipping from the Winston-
Salem Sentinel with a double column
headline, to wit: "No Deaths in Win-ston-
Salem This Year From Four of
Most Dreaded Diseases." This news-paper
item referred to the vital sta-tistics
of the first eleven months of
1936. The fact that the City of
Winston-Salem, a town of nearly
100,000 people having two widely
patronized hospitals, recorded no death
within its boundaries from typhoid
fever, scarlet fever, whooping cough,
or diphtheria is significant and en-couraging.
The Health Bulletin February, 1937
In many sections of North Carolina
(luring the Fall of 193G there was an
increase of diphtheria. Up to this time
no plausible explanation has been
forthcoming for this increase. How-ever,
the increase was a fact of dis-couraging
consequences to many lo-calities.
Our interest here in record-ing
the Winston-Salem record is for
the purpose of expressing the opinion
that this result was in no way an ac-cident.
Winston-Salem and Forsyth
County have enjoyed for some years a
thoroughly competent City and County
Health Department, respectively. Both
departments have been headed by
competent physicians who are trained
and conscientious health officers. Sus-tained
efforts throughout several years
have been directed toward the control
of these and other communicable dis-eases.
Despite the fact that some
populous territory in nearby counties,
which afford a source of constant in-fection
and which do not yet have
modern health facilities, the city was
able to make a showing of this kind,
is som.etiiing to encourage every health
officer in the State.
* * *
A S we have frequently pointed out ^ in these columns in years gone by,
this is the season of the year fraught
with various dangers to old people, to
people who are susceptible to so-called
colds, and to very young infants. In
short, it is a season of pneumonia and
other respiratory diseases. There has
been a large number of investigations
made by scientific groups in the past
few years in an effort to assemble as
much information as possible on the
loss of time and loss of life caused by
respiratory infections. In practically
every investigation the conclusions
reached are the same, and that is that
there is probably a greater loss of
time and a larger number of deaths
directly or indirectly due to respira-tory
infections than any other single
cause.
The common cold, as every one
knows, is often a forerunner of pneu-monia.
The fact is, all these respira-tory
conditions, influenza, pneumonia,
bronchitis and the common cold, so-called,
are frequently mixed up to-gether
in the same epidemic. No one
knows how many people suffer an-nually
from attacks of cold, how
much time is lost, or how many other
people are infected. It is well known
that these conditions are expensive as
well as dangerous. The only sound
advice that we can offer here is the
same old kind we have been offering
for many years, and that is to any
individual who has a cold that the
first and most important thing to do
is to go to bed, and unless the symp-toms
have cleared up within 24 or 48
hours to send for a qualified physician
and follow his instructions from then
on. Many lives would be saved and
many expensive epidemics would be
prevented if every person would fol-low
this rule. It is better to lose a
few days from work and upset the
routine of the family and the work-shop
or store or factory for a short
time than it is to become involved in
a serious illness.
Q OME time ago we noted in the of-
•^ ficial Health Bulletin of the Georgia
State Board of Health an item entitled
"Not All Dog Heads Show Rabies."
The Georgia Board's article interested
us very much. It stated that in a
recent issue of an Atlanta paper there
had been printed a syndicated article
on rabies by Charles B. Driscoll of
New York. In this article Driscoll
had insinuated that all heads of all
dogs sent to various state laboratories
for examination in the search for evi-dence
of rabies are always reported
as positive. The Georgia health writer
stated that the Driscoll statement was
not true as applied to the Georgia lab-oratory
and then proceeded to set forth
February, 1931 The Health Bulletin
the facts, that only 47 per cent of all
the dog heads examined for the year
1935 in that laboratory had been posi-tive
and an average of only about 45
per cent reported positive for a period
of years. These are about the same
figures that the North Carolina State
Laboratory of Hygiene has been able
to report for several years. The fact
is that not over 45 per cent of the
heads examined are reported as posi-tive
in any one year. The Driscoll
statement, however, is not the first of
this kind to come to our notice. There
is a type of writer who is very free
with information that he does not have.
They write with a cocksureness about
scientific matters, particularly mat-ters
affecting the medical profession
and the public health, with as little
regard to the truth and to the facts
as it would be hmnanly possible to set
forth. These writers generally flourish
as syndicate "scientists," and also get
a lot of their trash published in the
so-called physical culture publications.
We have had the assertion repeatedly
made by such writers and picked up
and reiterated by parrot-like repeaters
even in this State that the State Lab-oratory
of Hygiene is sure to make a
positive report when a dog's head is
sent. None of these smart alecks ever
take the pains to explain that our own
State Laboratory and probably all the
other laboratories in the country urge
people never to kill a dog when sus-pected
of rabies. That is the worst
thing that could be done. They are
advised repeatedly and everywhere to
shut the dog up. place it under the
observation of a competent veteri-narian,
when it is suspected of rabies
and after it has bitten a human being
or any other animal. The period of
observation may not exceed over two
weeks, and if the dog is still living
then it need not be killed and it need
not be considered as having rabies,
certainly in the infectious stages. It
is much easier to criticize physicians
and health oflBcers than it is to find
out the facts about any given situ-ation.
If writers like Mr. Charles B.
Driscoll would confine their talents
when they are exercising their pens to
something which they may know some-thing
about the whole country would
be much better off. Mr. Driscoll, we
believe, is a celebrated writer of pirate
stories. We would advise him to stick
to the pirate stories and let the rabies
situation alone. If he knows nothing
about pirates, nobody in the country
knows anything to the contrary, but it
is quite something else when he under-takes
to discuss practices of scientifi-cally
conducted laboratories, run under
the direction of competent state health
departments.
Progress In Maternal and Child Health Work
By George M. Cooper, M.D., Director, Maternal and Child Health Service
N. C. State Board of Health
WE are presenting this summa-tion
of activities somewhat in
the nature of an account of
stewardship. For about twenty years
the State of North Carolina has had
a birth rate recorded among the three
or four highest of all the states in the
Union. At one time Utah, at one other
time Alabama, and i)erhaps once or
twice South Carolina, has reported a
higher birth rate. In recent years
Arizona and New Mexico have led
the procession. Naturally where a
greater number of births according to
population prevail, the hazards of in-fancy
are greater. This is particu-larly
so in a state such as North Caro-lina,
having a large industrial and
6 The Health Bulletin February, 1937
tenant population, to say nothing of a
population composed of between 27 per
cent and 30 per cent Negroes. An
industrial population, particularly in
the textile industry, as well as a ten-ant
population on the larger farms,
means a shifting population, that is,
a population that is on the move at
least once a year. Their roots do not
go down deeply in the soil on which
they make their living, nor do they
become well grounded in the com-munities
in which they live as factory
workers. Poverty in many cases bor-ders
on the extreme, in such a mode
of life. A high mortality among in-fants
can only be expected. The
trouble in our State up to recent years
has been that we have accepted it in
a complacent manner and taken it as
a matter of course on the assumption
that nothing could be done about it.
There has been a small group of people
centered around the State Board of
Health and among the more thought-ful
citizens of the State who have not
been willing to be content with such
a complacent do-nothing attitude.
Along with the higher infant mor-tality
has been the accompaniment of
a higher maternal mortality than the
average for the Union. Beginning
about 1922, definite efforts were set
in motion by the State Board of
Health, aided by funds coming from
the Children's Bureau at Washington
under the Shepherd-Towner law ap-propriations.
The State was divided
into districts, a suj^ervising nurse was
assigned to each one, and about twenty
individual county nurses were assigned
to work purely with the maternal and
infant health problems in the coun-ties
most needing such services. This
work was continued until 1929. The
funds from Washington were discon-tinned,
the depression came on, and
appropriations for the State Board of
Health work reached the lowest level
in 1932 and 1933 that had been
touched in many years. Much of the
essential service of the State Board of
Health had to be discontinued and
only a skeleton organization was main-tained.
This situation prevailed until
the meeting of the Legislature in 1935,
when appropriations were increased so
that some of the work could be reor-ganized.
All through these years of
depression and despondency we have
kept the objectives steadily before us
and have worked with every facility
at hand to arouse the people through-out
the State and to save the lives of
these innumerable mothers and babies
such as have heretofore been needlessly
sacrificed.
Early in February, 1936, under the
provisions of the Social Security Law
enacted by Congress at Washington,
funds were made available to the State
Board of Health through the United
States Children's Bureau, so that a
comprehensive state-wide plan might
be gradually set in motion. On the
4th day of April the State plan for
operation under the Children's Bureau
regulations, together with a submitted
budget, was approved by the United
States Children's Bureau, and the of-ficials
of the State Board of Health
immediately inaugurated their plan of
work. Naturally, many obstacles
arose, but a steady effort has been
made to launch the work in the places
in the State where the needs seem
greatest. One of the obstacles to be
overcome was the lack of qualified
public health nurses. Some of the
difficulties will be more easily under-stood
when it is recalled that about
68 per cent or 69 per cent of the Negro
women in North Carolina are attended
in child birth by midwives. About 12
per cent to 14 per cent of the white
women are also attended solely by mid-wives
at the time of child birth. This
large group comprise about 25 per cent
to 28 per cent of the childbearing
women in the State. In some counties
this problem is not acute. For in-stance,
there are half a dozen counties
Felruary, 1937 The Health Bulletin
or more in the State in which the total
midwife deliveries for both Negro and
white women are not over 4 per cent
or 5 per cent. In some of those coun-ties,
however, the infant death rate
under one year of age, and particularly
under one month of age, is high.
In others of the counties the midwife
deliveries are as high as 65 per cent
and 70 per cent of the total.
In nearly all such counties we
have a high infant death rate.
Expectant mothers in this class de-pend
solely on the services of mid-wives
at confinement and receive no
prenatal medical care whatever. As a
consequence maternal deaths from such
conditions as toxemia and accidents
of child birth are high, nearly all
of which are preventable. Another
consequence also is that the death rate
from prematurely born babies, as well
as the resulting accidents in birth and
particularly under two weeks of age,
is very high. The sponsors of the
program in this State have believed
that to meet the problem involved in
this situation alone it would be neces-sary
to establish prenatal medical
service for every expectant mother in
the State at periodic intervals of at
least once a month during her expec-tancy
period. The sponsors of the
program also believe that it is
necessary for the newborn baby to
have competent care, medical and
otherwise, for the first few weeks of
its life. The chief difficulty in this
program has been to get together these
women, most of them from an indigent
class of women, at some central place
where a physician who is sympathetic
and competent could be induced to
devote some of his time to a careful
medical examination followed with the
necessary medical advice in cases
needing it. About 15 per cent of the
available funds has been budgeted for
this purpose, to be paid exclusively to
physicians. Each physician, of course,
could only be paid a nominal sum, but
sufficient to compensate him for his
expenses, at least, in rendering his aid.
Not having any provision for the
medical treatment or hospitalization
of women at confinement or of babies
who need such service, the weak link
in our progi*am has been the defi-ciency
of medical service at a time
when it is needed badly. We have en-deavored
to supply this need by work-ing
through the local welfare depart-ments.
In some counties this has been
satisfactorily done, but in many of
them little has been accomplished.
This is a problem that the organized
medical profession and the welfare
departments must work out between
them. For obvious reasons, we have
undertaken to restrict the clinic serv-ices
to expectant mothers and mothers
of young babies in families having no
family physician and not being able
to engage such service. We look upon
the whole effort as entirely educa-
' tional. We are undertaking to teach
by demonstration and example. One
of the hardest difficulties we have had
to overcome has been to make pro-vision
for the transportation of these
poor people to the centers on the days
when the doctors and nurses services
would be available. In the winter
months rains and bad roads make it
impossible for the good women who
have aided in this service to drive
their automobiles over the bad coim-try
roads. As one nurse put it, "You
know, these women that we expect to
get to the centers live on the back
country roads and they are hard to
reach." Another difficulty has been
to overcome the reticence of the
women in coming to the centers, even
though the medical service is free to
them. Most of them have no mode of
transportation of their own, except to
walk. Naturally they cannot come
very far. These problems will be
solved in due time. At the close of
the year this division of the State
Board of Health was paying for the
8 The Health Bulletin February, 19S7
services of an extra nurse in each of
seven counties having whole-time
health departments. It vpas paying for
half the services of such a nurse in
two additional counties having whole-time
health departments, and a pro-vision
was made for an additional
nurse in a whole-time county as soon
as a comiietent nurse could be secured.
Special nurses were working in 15
counties having no other form of whole-time
service, paid for solely by funds
from the Children's Bureau. A nurse
was engaged for the 16th county in
this class to begin work on the first
of January, and half the expenses of
a nurse in two additional part-time
counties were promised as soon as suit-able
nurses could be engaged.
At the close of the year 117 prenatal
centers were established and at work.
All of these centers, with the exception
of two in Cumberland County, one in
the City of Charlotte, seven in Robe-son
County, and one in Winston-Salem
were organized and started work
through the efforts of this division
since the 4th of April. Since the first
of April, services for crippled children,
working with the organized co-opera-tion
of the orthopedic surgeons in
some twenty of the general hospitals of
North Carolina were under way, and
two field nurses and a State Field Super-visor
were in the field extending aid
to many indigent cripples in the State,
this aid to include medical and hos-pital
service.
Following is a brief summary of some
of the tangible accomplishments
achieved up to the close of the year
:
1. Maternal and Child Health
Service
Total Maternity and Infancy
Centers (active) 117
Total counties represented 40
Children's Bureau special nurse
counties having Centers 16
City and County Health Depart-ments
having Centers 23
County with special arrange-ments
having Centers 1
Total visits by prenatal patients
to Centers 5,880
Total infant visits to Centers... 3,677
Number of Wassermann speci-mens
obtained in Centers 2,069
Number jwsitive 260
Per cent positive 12
In addition to the foregoing, a staff
of eight nurses paid exclusively by the
State Board of Health held midwife
classes in 45 counties and personally
examined and instructed about 1,500
midwives. The combined efforts of
these two groups of nurses, exclusive
of those working in whole-time organ-ized
counties, inspected about fifty
thousand school children in the period.
2. Work for Crippled Children
As most of the people in the State
know, the beginning of active work
for crippled children in this State on
an organized scale dates from the estab-lishment
of the orthopedic hospital
located at Gastonia, N. C. Beginning
with March, last year, when the United
States Children's Bureau approved the
State plan for Crippled Children Serv-ices
as proposed by the N. C. State
Board of Health, the work heretofore
done by the orthopedic hospital and
by various of the welfare offices. State
and local ; health departments. State
and local, and by the Department of
Vocational Rehabilitation in the State
government, the scope of the work was
extended and expanded to cover the
entire State. A field supervisor and
two specially trained orthopedic nurses
were employed by the State Board of
Health, an advisory committee of
orthopedic surgeons was secured with-in
the last quarter of the fiscal year,
and work for the entire State was in-augurated.
Up to the close of the year 1936
diagnostic and treatment of a perma-nent
nature in 17 clinics of the State
had been established. Some of these
February, 1937 The Health Bulletin
were old centers which are strength-ened
financially, and some of them
were new enterprises. Nine of the
orthopedic surgeons of the State, that
is, the surgeons who confine their prac-tice
entirely to orthopedic work, have
been co-operating in the examination
and treatment of patients. Twenty-five
general hospitals of the State had
been selected, providing about 78 beds
for the exclusive care of the cripples.
About 9,000 crippled children defined
under the plan as being cripples under
twenty-one years of age had been lo-cated,
and before the close of the fiscal
year's work about 1,000 children
will have had treatment and hospital
care provided. The hospital at Gas-tonia
has an annual turnover of 450
patients. Added to this number, the
beds in the general hospitals mentioned
above makes it possible now to care
for practically all of the cripples need-ing
hospitalization in the State at
present. The most important new fea-ture
in the work has been the follow-up
system, that is, the field workers
keep in contact with the patient from
the time the patient is located until
the medical, surgical, or public health
agencies are no longer necessary to the
welfare of the individual patient. At
present there is no reason for any child
in North Carolina to suffer for the
lack of hospital and surgical care on
account of an orthopedic condition.
Brief Notes On Bronchiectasis
By Thomas C. Woeth, M.D.
JUDGING from recent inquiries,
there is real need of clearer knowl-edge
about just what is meant by
bronchiectasis. A few details are
given here, in the hope that patients
will seek medical aid as early as pos-sible.
Before they can do this they
must know the outstanding signs and
symptoms, as well as understand
something about the disease process it-self.
Bronchiectasis (brong ke ek' tas is)
means dilated or enlarged bronchi
(divisions of the respiratory "tubes") ;
a dilatation which may vary from the
slightest possible degree, producing no
symptoms, to extensive dilatation in
patients who produce as much as
twenty ounces of exceptionally foul
sputum in twenty-four hours. Bronchi
may dilate in two main ways, one a
saccular and the other a cylindrical
form, without causing any difference
in the character of the symptoms.
Causes of bronchiectasis are numer-ous.
A rare type is found at birth.
Other cases may be due, first, to direct
infection—a real inflammation or
bronchitis (do not confuse with acute
bronchitis) with consequent weaken-ing
of the bronchial walls, so that when
any strain is imposed on them they
dilate, lose their elastic properties and
are unable to regain their former
shape. Such stress may come from
violent coughing, pressure from secre-tions,
or pressure from surrounding
lung tissue which has been damaged.
Secondly, cases may be associated
with scarring (fibrosis) of lung tissue
from any cause, but especially tuber-culosis
and pneumoconiosis (due to
prolonged inhalation of irritating
dusts-=-silicosis is an example) ; or
may be associated with some cases of
collapsed lung, due to causes not to
be dealt with here.
The actual offending bacteria have
not been too definitely shown. Pos-sible
ones are the influenza bacillus
;
a corkscrew-shaped organism with an
accompanying bacillus, or other combi-nations
of organisms.
10 The Health Bulletin February, 1937
By placing a special oil down into
the bronchi and taking X-rays it is
possible to detect very slight degrees
of bronchiectasis. If the lower lobes
or lung divisions are involved, as is
most usual, there is greater tendency
for accumulation of offensive sputum.
Tremendous quantities may be coughed
up during two or three daily "coughing
spells." These coughing paroxysms
are most marked early in the morning
and again at night when the patient
goes to bed. Blood-streaked sputum
or small hemorrhages may occur.
Shortness of breath is likely to be a
prominent symptom after the condi-tion
has been present some time. Pa-tients
may run slight daily tempera-ture,
or lose moderate amounts of
weight. However, even when there is
extensive involvement, they may look
and feel surprisingly well, which is in
marked contrast to what occurs in
tuberculosis.
When bronchiectasis has been pres-ent
for a long time, patients may begin
to lose weight rapidly, show evidences
of heart strain, are in danger of sec-ondary
brain and lung abscesses, and
are prone to develop broncho-pneu-monia.
One interesting and peculiar
feature about this condition is the fre-quency
with which the patient's fingers
become large and bulbous—the typical
"club fingers." This occurs often
enough to be of value in diagnosis.
Most important to bear in mind is
that while many tubercular patients
have some degree of bronchiectasis, not
by any means do all bronchiectatic
patients have tuberculosis. This is a
difficult and important differentiation.
Persons who begin losing weight, run-ning
slight temperature and raising
large amounts of sputum should not
only have physical and X-ray examina-tions
but should have repeated sputum
examinations. One sputum examina-tion,
reported as negative for tubercu-losis,
must not be thought conclusive.
Have a series of examinations made.
The outlook in severe bronchiectasis
is none too encouraging. Need for
reaching these cases earUer cannot be
over-stressed ; it is far easier to treat
an early case than a late one. Surgery
offers the best means of treating late
cases ; this consists in totally remov-ing
an entire lung division or lobe.
Recent advances in surgery of the chest
make this procedure relatively safe.
Drugs are disappointing, but are
helpful in reducing the amount and
the offensivenpss of the sputum, as
well as to aid in its expulsion. Placing
patients so that the head is in a de-pendent
position—postural drainage
—
is helpful in insuring free drainag.^
of sputum.
Such important factors as mild cli-mate,
sufficient rest, and adequate diet
are always to be regarded as essential
items in treatment and are never to
be neglected. Bronchiectasis, allowed
to become chronic, is a discouraging
problem. Its early recognition, with
prevention of further damage, is by
far the most logical and effective mode
of attack.
The Soul of Beauty
There are millions of people, chiefly
women, who seek to make themselves
beautiful by the aid of paints and cos-metics,
lipsticks and decorative gew-gaws
of various sorts. They need to be
taught that beauty is something which
is more than skin deep. It is something
which must come from within, and can
only be crudely imitated by such
camouflages as rouge and face powders.
Real beauty is not merely a physical
quality : it is an expression of charac-ter.
A beautiful face is an incarnated
expression of rectitude of conduct and
loftiness of character, if not in the
immediate iX)ssessor, in some near or
remote ancestor. Somewhere in the in-dividual's
pedigree, there has been a
beautiful life. One of the world's great-est
needs is an aristocracy of health,
beauty and character.
—
Good Health.
Feiruary, 1937 The Health Bulletin 11
Maternal and Child Health Work
In Charlotte, N. C.
By W. Z. Bradford, M.D.
THE increasing interest of the
American public in tlie problem of
maternal and infant welfare is the
result of an extensive campaign of lay
education. Following the reporTbf the
White House Conference in 1930 the
unnecessary dangers and the tragic
mortality rates of childbirth in this
country became a matter of common
information. Since that time the cam-paign
of public education to arouse the
public conscience to demand greater
protection for the childbearing women
of America has steadily gone forward.
This movement has taken on momen-tum
through the medium of articles
and editorials in magazines with a
wide circulation among women,
through various civic clubs (in our
own community the Kiwanis Club )
,
through various State, county and city
health offices, through the American
Legion, and through the General Fed-eration
of Women's Clubs, which has
taken a most active part in efforts to
improve the maternal mortality rates.
These are only a few public organiza-tions
active in this movement.
At the same time the American
Committee on Maternal Welfare, act-ing
in an advisory capacity with the
Children's Bureau of the U. S. De-partment
of Labor, is conducting an
active campaign through the medical
profession. The official purpose of this
committee as stated in its by-laws (in
part) is as follows: "The object for
which this corporation is formed is to
awaken and stimulate the interest of
members of the medical profession in
co-oi>erating with public and private
agencies for the protection of the
health of mothers and their offspring
before and during pregnancy and labor,
and after confinement, to the end that
the conditions which menace or inter-fere
with the health and life of the
mother and infant may be improved or
prevented, health promoted and life
saved." This committee has attempted
to stimulate commimity efforts toward
the development of their own re-sources
for adequate maternity and in-fant
care.
The basic fact of the preventability
of the overwhelming majority of ma-ternal
deaths and the possible reduc-tion
in infant mortality is especially
a challenge to us when we realize that
our Southern states have the highest
death rate of any in the Union. That
this rate can be reduced has been
proven. Such is accomplished by
awakening the public conscience as to
their responsibility to those unable to
afford competent medical facilities and
by stimulating the demand for im-proved
hospital and medical services
for the childbearing women of the com-munity.
It is my pleasure to briefly call to
your attention the efforts that have
been made in Charlotte to improve the
facilities for the care of mothers and
new-born infants. First, I would men-tion
the hospitals in the city of Char-lotte.
The hospitals of our community
have universally enlarged and de-veloped
their equipment for the han-dling
of the maternity patient. This
has been done according to standards
recommended by the American Hos-pital
Association and the American
College of Surgeons. Among these are
isolated delivery pavilions, special
floors or wings for the newly-born in-fant
and mother where they are re-moved
from the cross-currents of in-fection
present in the general hospitals,
also segregated nurseries, modern in-
12 The Health Bulletin February, 19S7
cubators for care of the premature,
improved anaesthesia facilities, etc. As
a result the combined maternal mor-tality
of three local institutions over
a three-year period was found to be
only 3 j>er 1.000. This is less than one-i
half the average mortality rat£__in__tlie.
State of North Carolinjvjand when the
large number of complicated patients
handled in these hospitals from other
communities is considered the high de-gree
of service rendered becomes ap-parent.
This is especially of note
when the increasing number of white
patients delivered in hospitals in the
city of Charlotte is considered. In 1932
fifty-five per cent, in 1933 fifty-seven
per cent, in 1934 sixty-three per cent,
and in 1935 seventy-two per cent of
the white infants born in this city were
hospital births. This is remarkable
in a State where only 8 per cent
total births are hospital-born
local hospitals are equipped and
staffed to handle these patients with a
minimum of danger and a maximum of
security and comfort.
Secondly, the problem of thj_ indi-gent.
It is estimated that there are
at the present time approximately
1,000 annual births in Charlotte and
Mecklenburg County in families with
incomes insufficient to afford private
medical services. The local Kiwanis
Club has for a number of years main-tained
an active and vital interest in
maternal welfare. Tlirough their sup-port
a maternity clinic for charity pa-tients
has been developed which now
handles over 750 annual births in this
community. Since its inception in
July, 1933, this clinic has delivered
over 2,500 infants in Charlotte and
Mecklenburg County. This clinic is
quite similar in its organization and
its service to the Maternity Center
Association in New York City. These
patients are unable to afford the serv-ices
of any physician and are given
thorough prenatal, delivery and post-natal
care. The combined efforts of
numerous organiza-tions^
rendeF^is work possible, among
them being the local city and county
health department, the Charlotte Ki-wanis
Club, Duke University, the
North Carolina State Board of Health,
the United States Government through
recently enacted social security legis-lation,
the Good Fellows Club, the
Charlotte Co-operative Nursing Asso-ciation,
the Family Service Bureau,
the Salvation Army, the American Red
Cross, and a number of members of
the local medical society. Out of this
combined effort a service has been
evolved resulting in a steady reduc-tion
of maternal and infant deaths in
this city and county, m'^here three
years ago only 40 to 50 per cent of
these patients consulted the clinic
prior to delivery, today 90 per cent are
given attention early in their preg-nancy.)
This has been made possible/
by education of this group of our popu
lace as to the importance of proper
maternal care, both for their owr
health and the preservation of the lift
of their new-born infant.
This organization has resulted in a
tremendous savings to the city and
county not only in actual lives but in
dollars and cents. The burden of hos-pitalization
of the charity obstetrical
patient has been reduced. Through the
intensive treatment of social diseases
present in over 20 per cent of these
patients, many new-born infants are
spared the ravages of congenital dis-ease.
This is bound to result in a re-duction
of penal and institutional care
as these children grow to adolescence
and adult life. "The value of an in-dividual
to the State is more often
than not dependent upon the manner
and the nature of its birth."—Dr.
Cliipmann, Montreal.
The most recent extension of the
scope of this maternal welfare pro-gram
in Mecklenburg County has been
the recent action of the board of
Fehruary, 1937 The Health Bulletin 13
county commissioners who at the re-quest
of Dr. E. K. Hand, county health
officer, have appropriated funds for the
development of prenatal clinics for
charity patients in isolated sections of
the county. These clinics are held in
Huntersville, Pineville, and Steele
Creek on consecutive Wednesdays at 1
p. m. By this means the indigent in
the rural regions will be able to ob-tain
medical services early in their
confinement, and it is hoped that the
maternal and infant mortality rates in
the county will show the same im-provement
that has been obtained in
the city of Charlotte.
If you reduce the activities of the
stork in Mecklenburg County to sta-tistics
you will find that in 1935 ap
proximately 25 per cent and in 1936
approximately 33 per cent of the babies
born were ushered into the world by
Duke Hospital interns under the
supervision of the Kiwanis Club
Charity Maternity Clinic. During the
calender year of 1935 this clinic de-livered
552 Charlotte and Mecklenburg
County babies. This figure will ap-proach
750 births in 1936. This clinitat
was given the highest rating of any!
activity of the City-County Health De-I
partment in a recent appraisal of local!
health activities made by the U. S.I
Public Health Service.
The mortality rate in this clinic is\
far less than that of all births in the
city of Charlotte, and it is one-third
the average mortality rate in the State
of North Carolina. The infant mor-tality
rate of approximately 3 per cent
is remarkable in contrast—te~-the-HP*t
in the best of society. ^In the public
that this clinic serves the incidence of
social diseases, tuberculosis, high blood
pressure and kidney disease, pellagra,
and other deficiency diseases that in-creases
the danger of childbirth to
both mother and infant is much higher
than in the remainder of society.
When the unfortunate environmental
surroundings of this group is consid-ered,
the poverty and social back-ground,
the possibilities of this type of
maternal care when applied univer-sally
over North Carolina and our
other Southern states becomes evident.
Such is the purpose of the maternal
welfare program of the Social Se-curity
Act. This clinic has recently
obtained $1,800.00 yearly through the
Social Security Act.* The Kiwanis
Club of Charlotte gave the first finan-cial
support that made the organiza-tion
of this clinic possible. At the
present time the Kiwanis Club funds
are used for records, certain instru-ments,
emergency medication, ambu-lance
transportation, X-rays, blood
transfusions, and accessory aid of an
emergency nature. An infancy clinic
has recently been established for fur-ther
care of babies delivered by this
service, especially for the further treat-ment
of those born under the handicap
of congenital social disease.
Over 95 per cent_of_these births oc-cur
in homes. Only complicated cases
are hospitalized. Thus the births in
hovels, in tenements, and slums and
in single-room shanties on the banks
of the Catawba, where sanitary condi-tions
range from poor to terrible,
where running water may exist only
when it rains, where the first light to
fall on a new life may be from a kero-sene
wick or a flashlight tucked under
the arm of a young interne and where
the new-born's first bed may be cov-ered
with old newspapers instead of
soft sheets, life is brought into the
world with a high degree of safety and
efficiency. Eight subsequent visits are
made to these homes by visiting nurses,
laboring under the wing of the Good
Fellows Club through the Charlotte
Co-operative Nursing Association.
Awarded through the Department
of Maternal and Child Health Service
of the North Carolina State Board of
Health.
14 The Health Bulletin February, 1937
Three subsequent visits are made by
the physician. Last year student phy-sicians
made 3,500 visits to see pa-tients.
Tliere were 3,217 other visits
to the clinic by expectant mothers.
In conclusion let me add that dur-ing
the past few years a number of
extensive studies on maternity care
have been made, chief of these being
the investigations of the Children's
Bureau of the U. S. Department of
Labor, the Commonwealth Fund, and
the Maternity Center Association of
New York City. Because of the vast
scope of these studies the basic find-ings
are not limited to any one locality
nor to any one group of people. It was
found in general that maternal and in-fant
mortality rate is due to the fact
that many mothers have care which
is inadequate to make maternity safe.
Ignorance was found as one of the
chief causes of the inadequate care.
Ignorance on the part of the expectant
mothers and their families kept some
from seeking good care when it was
available. This ignorance and apathy
of the individual and family is re-flected
in the lack of public interest
and public provision for good maternity
care. The city of Charlotte and Meck-lenburg
County are exceptions to this
finding, for through the medium of this
organization even the more unfor-tunate
women in this community have
been taught the need of medical advice
early in pregnancy. As a result the
vital statistics of 1937 concerned with
maternity and infancy welfare are
those which the citizens of Charlotte
and especially the Kiwanis Club may
well be proud.
Endemic Typhus In North Carolina-
Believed To Be Transmitted By Rat Flea
By Mrs. J. Heney HiGHSMiTH, state Board of Health
THE appearance of thirty or more
cases of typhus fever in North
Carolina during 1936, resulting in
three deaths, is cause for no great
alarm ; however, the severity and fa-tality
of the disease are serious enough
to warrant every precaution being
made to prevent its spread. Especially
is this true now since the question as
to how this disease is carried from
man to man, long a controversial mat-ter,
is believed to have been settled.
Typhus fever is associated in the
minds of most Americans with the
World War, armies, camps, and
trenches. The body louse or "cootie,"
as the doughboys called it, was known
to be the carrier. But the typhus that
is found in North Carolina and other
Southern states today is not the epi-demic
form which was so prevalent
during the World War and which is
still more or less common in many
countries of Europe and other parts of
the world. Neither is it the type that
is associated with slums, filth, and
squalor. It is a more benign type,
less severe in its reactions and having
a low fatality rate. The rate is usu-ally
about 5 per cent or one death In
twenty cases. However, the fatality
varies with age—less than 2 per cent
imder 45 years and about 30 per cent
above 65 years. This disease found in
many of the southeastern states is be-lieved
to have come from Mexico. In
many respects it resembles "Tabar-dillo,"
the Mexican form of typhus.
Both the epidemic and endemic
forms of typhus are said to be caused
by the same germ, the only difference
being a new host and a new means of
transportation for the endemic type.
It is well known that the epidemic
February, 19S7 The Health Bjlletin 16
typhus is borne from man to man by
the body louse, and it is reasonably
certain that the endemic type is borne
from rat to man by the rat flea. The
epidemic typhus is more deadly, shows
a decided preference for cities, espe-cially
crowded slums, and prevails
during the winter and spring. It is
highly communicable. Endemic typhus
shows a preference for rural communi-ties
and has its maximum incidence
during the summer and fall. It does
not spread as rapidly as the epidemic
type and is less fatal.
In both forms, the disease is marked
by a sudden onset with headache, diz-ziness,
and a fever lasting usually
about two weeks. There is always a
rash, a most characteristic symptom,
which appears about the fifth day and
lasts from two to ten days.
According to the July-September re-port
of the Health Section of the
League of Nations, there are four types
of typhus-like diseases in the United
States, these not including the louse
borne type. The endemic benign form
known as Brill's Disease is one of the
group, but it is not to be confused with
the t3T>e found in the South. In re-cent
years numerous studies have been
made of this newer type of typhus
fever in order to find its host and
means of transmission. Kenneth F.
Maxcy, past Assistant Surgeon of the
United States Public Health Service,
was the first to point out that all evi-dence
was against louse transmission
and to suggest that the reservoir might
be the rat. This assumption was later
verified by his co-workers. Dyer,
Badger, Ceder, Kumreich, Workman,
and Kemp. These workers are now
agreed that the disease actually has
its reservoir in rats and that it is
transmitted from rat to rat and occa-sionally
from rat to man by rat fleas.
The question then is, will endemic
typhus, which is flea borne from rats
to man, become in the future as wide-spread
and devastating as epidemic
typhus, louse borne from man to man,
has been in the past? The answer to
this question, it stands to reason, will
depend on the control or lack of con-trol
of rats. To eradicate endemic
typhus it will be necessary to eradicate
rats.
A distressing note concerning ty-phus
fever in the South is that it is
on the increase. "Birmingham's
Health," a bulletin published monthly
by the Jefferson County Board of
Health of Alabama, reports that the
disease began to appear in South Ala-bama
about 1921, and since that time
there have been no less than 2,500
cases of the disease and 102 deaths.
The Bulletin says:
"The highest incidence was in 1933
when 823 cases were reported. In the
first nine months of 1936 266 cases
were reported of which eight occurred
in Jefferson County. Thus the disease
is apparently on the increase in this
territory. While the majority of Ala-bama
cases have been in rural areas,
association with food handling estab-lishments
constitutes an important fac-tor
in urban cases.
"Negroes are relatively free from
the infection, the attack rate being ap-proximately
one-tenth of that of the
white population. Adults are more
often attacked.
"The disquieting fact must be faced
:
typhus has secured a dangerous foot-hold
in certain sections of this State
and each year is spreading northward
in increasing incidence. A broad pro-gram
for the control and eradication
of rats is, therefore, an immediate
public health necessity."
The League of Nations Journal re-cently
issued is also of the opinion
that endemic typhus is on the increase
in the United States. It says:
"It seems that murine typhus (rat
borne) in man has been increasingly
frequent in the United States. In Ala-
16 The Health Bulletin February, 1937
bama, for instance, some 60 to 80 cases
per year have been reported since
Maxcy and Havens discovered it in
1922 througli the Weil-Felix reaction.
It was limited to the cities of the south
and southeastern part of the State.
In 1932 the number of cases rose to
237 (11 deaths) and in 1933 to 823
(35 deaths). The disease had spread
to strictly rural areas without modi-fying
either its mode of spread or its
fatality (Baker, McAlpine & Gill,
1935). In Texas, 417 cases were re-ported
in 1934 against 5 in 1922
(Bohls, 1935). A check in the increase
was, however, obtained as a result of
extensive rat-destruction campaigns in
Texas, Alabama and Georgia."
POISON AND EXPLOSIONS CALSK
MANY HOUSEHOLD ACCIDENTS
Carbon monoxide poisoning, defec-tive
electrical cords, explosions from
cleaning fluids and medicinal poisoning
from administration of the wrong
medicine on the cabinet shelf—all con-tribute
to the high accident toll found
in the home, according to Dr. Louis
L. Lefkowitz who writes of these in
the December Hygeia.
Carbon monoxide poisoning, which
results from the use of illuminating
gas, may be guarded against if the
following points will be observed : 1.
Investigate every odor of gas immedi-ately.
2. Keep all rooms containing
gas fixtures well ventilated at all
times, assuring a good supply of fresh
air. 3. Exercise close supervision of
cooking food so that it will not boil
over and extinguish flame, allowing
free gas to escape. 4. Make certain
that the pilot light is lit or the gas
supply shut off. 5. Where gas heaters
are used see that all connections and
pipes are tight. 6. Before retiring
shut off all gas jets and open the win-dows.
MILK
1. For good health, milk should be
included in the diet of every man,
woman and child. Of all foods, milk is
the outstanding and, in fact, the most
important single food known.
2. Milk improves health. It brings to
our bodies all of the important things
we need for energy and growth, and
when used with vitamin D, found in
sunshine, cod liver oil or viosterol,
helps to make good bones and good
teeth. Milk is our best source of cal-cium,
so necessary for teeth and bones.
3. Milk should not be limited to in-fants,
who thrive on it. It is also an
essential food for the growing child.
It is an essential food for adults, too.
It is imperative that pregnant and
nursing mothers have milk if babies
are to develop and thrive as they
should.
4. The recommendation of nutrition
and health authorities that more milk
be used should be given serious con-sideration
by all parents. If this ad-vice
is followed, growing children will
receive the amount of milk necessary
for good health and strong bodies.
5. All children should have a quart
of milk every day, and adults at least
one pint. Use milk freely—as a drink,,
hot or cold, plain or flavored; with
puddings, cereals, cream soups ; or as
ice cream.
6. Compared with other foods of
similar values, milk is the cheapest;
never "stint" with milk.
7. Remember
:
Tour child needs milk for his healtb
and growth.
You need it to keep your health.
Don't deprive yourself and your fam-ily
of the most nearly perfect food.
There is no substitute for milk!
—
Agricultural Review.
nrr ^%d
This Dullelirvwillbe 3er\1 free to qtmj ci-hzen of the Stole upor\rec[ue5t |
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894,
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 52 MARCH, 1937 No. 3
E. R. HARDIN, M.D., LUIVIBERTON, N. C.
For the Past Sixteen Years Health OflScer of Robeson County
Above is a photograph of Dr. Hardin, who recently began his seventeenth year
as full time health officer of Robeson County. He enjoys the distinction of prob-ably
being the only health officer in North Carolina to have the question of
continuance of his department work submitted to a vote of the people. A few
years ago a Robeson legislator put such an act through the Legislature. The
election resulted in an eight to one popular vote in favor of Dr. Hardin and
his department work.
He has rendered a valuable service to the people of Robeson County, par-ticularly
in his work for mothers and babies among the poor.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. Craig, M.D., President _ „ _ Winston-Salem
J. N. Johnson, D.D.S.. Vice-President _ Goldaboro
G. G. Dixon, M.D - Ayden
H. Leb Large, M.D _ _ Rocky Mount
H. G. Baity, ScD _ _ _Chapel HiU
W. T. Rainey, M.D Fayettevitle
HUBBRT B. Haywood, M.D „ - Raleigh
Jambs P. Stowb, Ph.G _ —• Charlotte
J. LaBruce Ward. M.D - _ - ^.Aaheville
Executive Staff
Carl V. Reynolds, M.D., Secretary and State Health Officer.
G. M. CooPEiR, M.D., Assistant State Health Officer and Director Division
of Health Education. Crippled Children's Work, and Maternal
and Child Health Service.
Warren H. Booker, C.E.. Director Division of Sanitary Engineering
and Malaria Control.
Ernest A. Branch, D.D.S., Director Division of Oral Hygiene.
John H. Hamilton, M.D., Director Division of Laboratories.
J. C. Knox, M.D., Director Division of Epidemiology and Venereal
Disease Control.
R. T. Stimson, M.D., Director Division of Vital Statistics.
R. E. Fox, M.D., Director Division of County Health Work.
H. F. Easom, M.D., Director Division Industrial Hygiene.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly
which will be sent free to any citizen requesting
available for distribution without charge special
lug subjects. Ask for any in which you may be
Adenoids and Tonsils
Cancer
Constipation
Chickenpox
Diabetes
Diphtheria
Don't Spit Placards
Eyes
Flies
Fly Placards
German Measles
Health Education
Hookworm Disease
Infantile Paralysis
Influenza
Malaria
Measles
Pellagra
Residential Sewage
Disposal Plants
Sanitary Privies
The Health Buixetin,
it. The Board also has
literature on the foUow-interested.
Scarlet Fever
Smallpox
Teeth
Tuberculosis
Tuberculosis Placards
Typhoid Fever
Typhoid Placards
Venereal Diseases
Water Supplies
Whooping Cough
SPECIAL LITERATURE ON
The following special literature on
free to any citizen of the State on r
Raleigh, N. C.
Prenatal Care (by Mrs. Max West)
Prenatal Letters (series of nine
monthly letters
)
Minimum Standards of Prenatal Care
Breast Feeding
Infant Care. The Prevention of
Infantile Diarrhea
Table of Heights and Weights
MATERNITY AND INFANCY
the subjects listed below will be sent
equest to the State Board of Health,
Baby's Daily Time Cards : Under 5 monthi
;
5 to 6 months ; 7, 8, and 9 months ; 10
11, and 12 months : 1 year to 19 months
19 months to 2 years.
Diet List: 9 to 12 months ; 12 to 15
months ; 16 to 24 months ; 2 to 8
years ; 3 to 6 years.
Instructions for North Carolina Midwives.
CONTENTS
Pags
Notes and Comment 8
Prenatal Clinics in Raleigh 5
N. C. Bureau of Vital Statistics—Provisional Report for 1936 _ _. 6
Facts Concerning Self-Medication 6
Vital Statistics Records 7
Results Obtained in Prenatal Clinics at Rex Hospital and St. Agnes Hospital in Raleigh 9
Acne in Young People—Its Cause and Treatment 11
National Negro Health Week Observance _ 18
Wives of State Officials Propose Syphilis Tests for Domestic Servants 15
Total Number Births and Deaths Under One Year of Age (Exclusive of Stillbirths) in
Each County with Rates per 1.000 Live Births: 1935 16
I PUBLI5ME.D BY TMEL noR.TA CAgQUMA 5TATL BOAgD "XMLALTM |
Vol. 52 MARCH, 1937 No. S
Notes and Comment
By The Editob
MARCH is the month of the year
when the lengthening days and
the increased hours of sunshine
make outdoor life more pleasant and
therefore begin to dispell the colds and
sniffles of winter. It begins to bring
the color back to the babies' cheeks and
relieves the mothers of much nervous
strain in caring for their little ones
kept inside the house for so many
weeks.
There is one aspect, however, that
such change in conditions and living
habits bring about which is not so
pleasant, but is disturbing. It is the
traditional habit, more a habit of
mind, of dosing the entire family with
laxatives and purgatives and what-nots.
It is the golden period for the
sellers of so-called "tonics" and "re-juvenators"
and "blood builders," etc.
In the old days, the molasses and sul-phur
habit followed by the very pleas-ant
custom of several weeks indul-gence
in sassafras tea was not nearly
so bad as the present methods of de-pending
on the various "patent" medi-cines
advertised so promiscuously in
almost every newspaper and over
nearly all the radio stations.
The matter of regulating one's way
of living, that is, the personal hygiene
we might call it, is a matter for each
individual to decide for himself.
Every one should partake of some
essential foods known as protective
foods in the diet daily. Such foods
comprise vegetables, fruits, some meats,
and plenty of milk and dairy products.
The foregoing are known as protective
foods, and some of them are essential
for good health for everybody.
The vitamin racket as practiced to-day
is probably one of the worst in the
realm of food which the country has
ever experienced. Knowledge of foods
has been wonderfully increased by the
discovery and scientific study of vita-mins,
but the trouble is half truths
have been seized upon by commercial
interests and the people are being ex-ploited
world without end. They are
being urged to spend their money for
this, that, and the other as containing
the necessary vitamins, without which
the prospective patron would immedi-ately
die, and one of the troubles is
that people are urged that such essen-tial
elements in the food or medicine
could nowhere else be obtained except
in this particular product right then
being advertised. The old custom still
stands as the best possible advice for
people to follow, and that is a balanced
diet comprising some of the essential
foods in every day's diet.
The question of self-medication has
become one of the most serious that
people have to contend with, owing
to the intensive advertising carried on
today by a few unscrupulous dealers
in remedies which are far from safe.
The Health Bulletin March, 1957
In this connection, we want to call at-tention
to an article in this issue by
Dr. S. V. Lewis, Assistant Health Offi-cer
of the Orange-Person District
Health Department at Roxboro. The
title of the article is "Facts Concern-ing
Self-Medication." The reader will
find Dr. Lewis' article very interest-ing.
Dr. Lewis very properly empha-sizes
the most essential requirement
which must be established before any
medication of any kind is taken by
any human being, and that is a diag-nosis
must be made first. This is one
of the hardest things that a physician
has to do. It is certainly more rea-sonable
to believe that a physician who
has had long years of experience in
study and treatment of disease is more
capable of making a diagnosis than
one who has never given the matter a
thought except when he might have
an ache or pain. The Sairey Gamps
and the fishwives have been with the
world since time immemorial. The
radio announcers with a pleasant
voice who daily send out over the air
accounts of the wonders of certain
medicines and the cocksure newspaper
advertisers who daily publish the so-called
virtues of the various remedies
advertised to satisfy the desires for
self-medication are nothing more nor
less than polished, educated Sairey
Gamps and fishwives. There is one
vital difference, however, and that is
that the Sairey Gamps and the fish-wives
of tradition have always given
their advice free and without price,
and with no other motive than that
they just simply love to tell other
folks what to do and to pose as the
possessors of wisdom the average hu-man
does not have, but the Sairey
Gamps and the fishwives of today in
their advertisements over the radio
and in the newspapers are carrying
on the fishwives' traditions for the
money there is in it.
Once again we offer the free advice
here that when medication of any kind
is needed, the best policy to pursue is
to let a competent physician prescribe
what is to be taken.
fT^ HE newspapers some weeks ago
carried a most gratifying item sent
out from Detroit, Michigan. We re-fer
to the dispatches describing the
roundup by Federal police agents of
a group of ten or twelve eye "doctor"
fakers who have been operating for
many years all over the country. We
have been mentioning from time to
time in these columns the activities
of these fakers in North Carolina. We
have urged people everywhere to re-fuse
to have dealings of any kind with
these traveling frauds and robbers.
Notwithstanding all our urgent warn-ings
and warnings of many other peo-ple
in the State by newspaper publicity
during the last fifteen years, we feel
sure that these fakers have defrauded
people in North Carolina of hundreds
of thousands of dollars of hard-earned
money. The newspapers did
not follow through with the outcome
of the trial. As Michigan does not
have a capital offense law and there-fore
they cannot be hung in that state,
the best that we hope for is a life im-prisonment.
That would be getting off
entirely too easy, but it is the best
that could be expected. In any event,
we hope they have them all.
It will be remembered that some
years ago two of the most active were
arrested by a deputy sheriff up in
Forsyth County. They were released
on a $2,000 bond, which they promptly
forfeited and were never heard of
again. We fear, however, that the
racket was so successful and so pro-ductive
of big money that the Federal
agents have not rounded them all up.
It would, therefore, be wise for our
readers to decline to do business with
March, 1937 The Health Bulletin
any kind of an agent who comes to
one's home with the proposition to
talk about eye diseases or to sell medi-cines
of any kind. We still insist that
if at any time in the future one of
these traveling eyeglass fakers comes
to one's home, the best plan to follow
would be to detain them long enough
for the police or the sheriff to be
called and have an arrest made at
once. Id * *
TpOR several years pediatricians have
insisted that a daily ration of cod
liver oil should be given to every new-born
baby until it is about eighteen
months of age. This should be given
every day as a precaution against the
nutritional disturbances which would
eventually have such disastrous re-sults
on the babies' teeth formation
and the bony system of the body. Such
deficiencies frequently are evidenced
in such diseases as rickets.
The nurses working for the State
Board of Health have always been
urged to advise the parents of babies
to carry out this policy, especially in
cases where the babies show evidence
of nutritional deficiencies. One of our
nurses recently reported that some
manufacturing concern selling cod liver
oil had given her a large supply to
give out as samples. A druggist
friend of hers divided the samples in
2-ounce bottles and she presented it
to some mothers of babies who were
specially in need of this vital element
in their diet with such satisfactory
results that the druggist reported later
a very large return of the sample bot-tles
for more of the stuff to be pur-chased
direct. They were convinced
of the improvement in the babies' con-dition
in a short time.
We call attention to this in the hope
that the habit will be more generally
followed in remote sections where the
babies so urgently need such care.
Prenatal Clinics In Raleigh
In our February issue we published
an article by Dr. W. Z. Bradford of
Charlotte, the title of which was
"Maternal and Child Health Work in
Charlotte, N. C." On reading this
article a group of physicians here in
Raleigh who have been doing con-siderable
work along the same lines
described by Dr. Bradford were very
much interested in the Bradford
article, and all of us feel that our
readers will be much interested in
knowing of the progress being made
along this line by this group of Raleigh
physicians. We requested Dr. Verne
S. Caviness of Raleigh, who was fa-miliar
with the work, to write a brief
description of what has been done
here. This article by Dr. Caviness
will be found in this issue.
Just a few years ago about one-third
of the deliveries of babies in
the city of Raleigh were by midwives.
Of course the majority of them were
Negroes, but there were many white
women dependent on midwives. Every-body
will be interested in the state-ment
Dr. Caviness makes that no
white woman in Raleigh has been at-tended
by a midwife in more than a
year. Another rather amazing state-ment
is that in the eight years that
this work has been under way there
has not been a death of any mother
who regularly visited the prenatal
clinics. It must be understood, of
course, that these clinics are strictly
for indigent women.
The description of the work here,
following the article describing the
work in Charlotte, is evidence of prog-ress
now being made in various parts
of the State which will eventually lead
to a material reduction in the maternal
and infant death rate in North Caro-lina.
The Health Bulletin March, 19S7
NORTH CAROLINA BUREAU OF VTTAX. STATISTICS
PROVISIONAL. REPORT FOR 1936
1935
Total number deaths... 85,834 83,451
Death rate 10.4 9.8
Total number births.... 76.869 79,596
Birth rate 22.2 23.3
Infant deaths (under
one year) _ 5,184 6,407
•Infant mortality rate 67.4 67.9
Maternal deaths 499 664
Maternal mortality rate 6.6 7.0
No. Rate No. Rata
Typhoid and para-typhoid
fever 76
Endemic typhus fever 8
Undulant fever 3
Smallpox
Measles 9
Scarlet fever 25
Whooping cough 35
Diphtheria _ 190
Influenza 1114
Acute poliomyelitis
and polioencephalitis 12
Epidemic cerebrospinal
meningitis _ 54
Rabies 5
Tetanus 29
Tuberculosis, pulmo-nary
1896
Tuberculosis, other
forms 200
Syphilis, locomotor
ataxia, paresis 406
2.2
0.09
0.09
0.3
0.7
1.0
5.5
32.2
0.3
1.6
0.1
0.8
1
69
22
308
168
1033
2.4
O.OS
2.0
0.6
9.0
4.9
80.2
72 2.1
38
6
24
1.1
0.2
0.7
64.8 1761 61.5
5.8 175 6.1
11.7 408 11.8
No.
Malaria _ 150
Cancer, all forms _1789
Diabetes mellitus 400
Pellagra 849
Pneumonia, all forms. .3480
Diarrhea and enteritis
(under 2 years) 812
Appendicitis 818
•Puerperal septicemia.. 115
•Puerperal, other forms 384
Suicide 282
Homicide 864
PREVENTABLE ACCIDENTS
Rate
March, 1937 The Health Bulletin
treated, and then is able to prescribe
such drugs as may produce the desired
results; otherwise, if drugs are admin-istered,
they may produce undesired or
even dangerous results.
The pure food and drug act pro-hibits
the sale of preparations adver-tised
to cure tuberculosis, caucer, and
other malignant diseases. All prepara-tions
must contain ingredients as ad-vertised
on the package, but the medi-cine
manufacturer is not required to
label his concoctions unless they con-tain
poisonous drugs such as acetana-lid,
strychnine and some others, and
only rarely does the purchaser realize
the significance of such drugs as are
mentioned on the label and their dan-gerous
character. Since so many
highly advertised patent remedies con-tain
poisonous drugs, the only safe
policy is to secure a physician's advice
regarding a preparation before inflict-ing
it on the system.
A close observation of avertising
propaganda will reveal that the various
remedies flaunted before us from maga-zines,
newspapers or billboards, and
over the radio are usually not adver-tised
as cures for diseases, but as re-lief
for certain symptoms. However,
the advertisements are frequently so
cleverly worded that the very decided
suggestion is received that they are
cures.
I do not deny that some of the prep-arations
used in self-medication could
be of some benefit if we knew two
very imjwrtant facts. First, if we
knew what disease or condition web
present. Second, if we knew what
drugs or substances were in the prep-aration,
something that is not usually
known unless the preparation contains
some of the poisonous drugs that must
be labeled in order to comply with the
law. Thus, self-medication with patent
medicines is really the treatment of a
condition whose nature is not known
with a remedy regarding the real ef-fects
and dangers of which we are
totally ignorant. Hardly a very in-telligent
procedure, is it?
When advised to take this or that
for acid indigestion, why and how do
we know our symptoms are not due to
stomach ulcers or cancer of the stom-ach?
It is not justice to ourselves to
take some preparation advertised to
establish the alkaline balance, when
there may be some malignant disease
causing the disturbance, if indeed our
trouble is in any way connected vrtth
the alkaline balance. Remedies con-taining
poisonous drugs are advertised
for the relief of inorganic pains, but
the advertisements do not tell that
death may occur if the remedy is taken
by one having an organic heart dis-ease.
The most of us may not be expected
to look for the things omitted in medi-cine
advertising, but for the safety of
ourselves and our families, we can re-frain
from self-medication and go to a
physician with our ills. He is the only
one competent to diagnose and treat
them.
Vital Statistics Records
IN this issue we are publishing two
sets of vital statistics figures
which should be interesting to all
our readers. The first item we will
mention is a comparison between the
records for 1935 and those for 1936.
These tables will be found elsewhere
in this issue. In one of the tables we
are presenting such information as the
total number of deaths and births oc-curring
in the State in 1935 and 1936.
The 1935 figures are final, that is,
they are what we call adjusted fig-ures.
The items for 1936 are what
8 The Health Bulletin March, 19S7
is called provisional, that Is, they will
be subject to slight changes later on.
It will be noted that the birth rate
was approximately one point lower in
1936 than it was the previous year,
there being nearly 3,000 fewer births
last year than there were the year
before. It will be noted also that the
number of deaths of infants under one
year of age last year was fewer, but
there was not a sufficient decrease to
materially change the rate, although
it was reduced half a point.
The maternal mortality was a little
lower last year than the previous year.
It is gratifying to point out that ty-phoid
fever continued its steady de-cline,
reaching the lowest rate in the
history of the State. The rate on
diphtheria, however, was increased.
Deaths from influenza in each of the
two years ran considerably over 1,000.
the rate being higher last year than
the year before. The deaths from in-fantile
paralysis reached almost to a
subnormal level, which was quite a
contrast to the rate of the preceding
year.
One of the most disturbing aspects
in this report is that there were eleven
deaths in the two years from rabies,
six in 1935 and five last year. All
these deaths were diagnosed as hydro-phobia
beyond any question of doubt.
All of them were tragic, and the de-scriptions
in the Leaksville and
Reidsville papers of one of these
deaths which occurred in Rockingham
County were classics. These news-papers
described the death in that
county as being terrifying in every
particular. There is no excuse for
any human being in this State to die
from rabies, as a few simple restric-tions
of state-wide character could be
enforced in the control of dogs. All of
us note every day in our journeys
here and there flocks of dogs, large
and small, vicious and otherwise,
roaming at large on the streets and
in the roads, mingling with children,
none of them muzzled or under con-trol
of their masters. It is a disgrace-ful
situation.
It will be noted that there was a
slight increase in the number and rate
in deaths from tuberculosis. Deaths
from syphilis remained about the
same. Malaria caused 150 deaths last
year as compared to 94 the preceding
year. There was a reduction in the
deaths from pellagra, although 349
people died last year from that dis-ease.
Pneumonia again led the pro-cession
as the

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—^ DREAMS ^
By Dr. Milton J. Rosenatj
"Preventive medicine dreams of a time when there shall be
enough for all, and every man shall bear his share of labor in
accordance with his ability, and every man shall possess suf-ficient
for the needs of his body and the demands of health.
These things he shall have as a matter of justice and not of
charity.
"Preventive medicine dreams of a time when there shall
be no unnecessary suffering, and no premature deaths ; when
the welfare of the people shall be our highest concern; when
humanity and mercy shall replace greed and selfishness; and
it dreams that all these things will be accomplished through
the wisdom of man.
"Preventive medicine dreams of these things, not with the
hope that we, individually, may participate in them, but with
the joy that we may aid in their coming, to those who shall
live after us.
"When young men have vision the dreams of old men
come true."
•V
•V
.
V
V
>erating with public and private
agencies for the protection of the
health of mothers and their offspring
before and during pregnancy and labor,
and after confinement, to the end that
the conditions which menace or inter-fere
with the health and life of the
mother and infant may be improved or
prevented, health promoted and life
saved." This committee has attempted
to stimulate commimity efforts toward
the development of their own re-sources
for adequate maternity and in-fant
care.
The basic fact of the preventability
of the overwhelming majority of ma-ternal
deaths and the possible reduc-tion
in infant mortality is especially
a challenge to us when we realize that
our Southern states have the highest
death rate of any in the Union. That
this rate can be reduced has been
proven. Such is accomplished by
awakening the public conscience as to
their responsibility to those unable to
afford competent medical facilities and
by stimulating the demand for im-proved
hospital and medical services
for the childbearing women of the com-munity.
It is my pleasure to briefly call to
your attention the efforts that have
been made in Charlotte to improve the
facilities for the care of mothers and
new-born infants. First, I would men-tion
the hospitals in the city of Char-lotte.
The hospitals of our community
have universally enlarged and de-veloped
their equipment for the han-dling
of the maternity patient. This
has been done according to standards
recommended by the American Hos-pital
Association and the American
College of Surgeons. Among these are
isolated delivery pavilions, special
floors or wings for the newly-born in-fant
and mother where they are re-moved
from the cross-currents of in-fection
present in the general hospitals,
also segregated nurseries, modern in-
12 The Health Bulletin February, 19S7
cubators for care of the premature,
improved anaesthesia facilities, etc. As
a result the combined maternal mor-tality
of three local institutions over
a three-year period was found to be
only 3 j>er 1.000. This is less than one-i
half the average mortality rat£__in__tlie.
State of North Carolinjvjand when the
large number of complicated patients
handled in these hospitals from other
communities is considered the high de-gree
of service rendered becomes ap-parent.
This is especially of note
when the increasing number of white
patients delivered in hospitals in the
city of Charlotte is considered. In 1932
fifty-five per cent, in 1933 fifty-seven
per cent, in 1934 sixty-three per cent,
and in 1935 seventy-two per cent of
the white infants born in this city were
hospital births. This is remarkable
in a State where only 8 per cent
total births are hospital-born
local hospitals are equipped and
staffed to handle these patients with a
minimum of danger and a maximum of
security and comfort.
Secondly, the problem of thj_ indi-gent.
It is estimated that there are
at the present time approximately
1,000 annual births in Charlotte and
Mecklenburg County in families with
incomes insufficient to afford private
medical services. The local Kiwanis
Club has for a number of years main-tained
an active and vital interest in
maternal welfare. Tlirough their sup-port
a maternity clinic for charity pa-tients
has been developed which now
handles over 750 annual births in this
community. Since its inception in
July, 1933, this clinic has delivered
over 2,500 infants in Charlotte and
Mecklenburg County. This clinic is
quite similar in its organization and
its service to the Maternity Center
Association in New York City. These
patients are unable to afford the serv-ices
of any physician and are given
thorough prenatal, delivery and post-natal
care. The combined efforts of
numerous organiza-tions^
rendeF^is work possible, among
them being the local city and county
health department, the Charlotte Ki-wanis
Club, Duke University, the
North Carolina State Board of Health,
the United States Government through
recently enacted social security legis-lation,
the Good Fellows Club, the
Charlotte Co-operative Nursing Asso-ciation,
the Family Service Bureau,
the Salvation Army, the American Red
Cross, and a number of members of
the local medical society. Out of this
combined effort a service has been
evolved resulting in a steady reduc-tion
of maternal and infant deaths in
this city and county, m'^here three
years ago only 40 to 50 per cent of
these patients consulted the clinic
prior to delivery, today 90 per cent are
given attention early in their preg-nancy.)
This has been made possible/
by education of this group of our popu
lace as to the importance of proper
maternal care, both for their owr
health and the preservation of the lift
of their new-born infant.
This organization has resulted in a
tremendous savings to the city and
county not only in actual lives but in
dollars and cents. The burden of hos-pitalization
of the charity obstetrical
patient has been reduced. Through the
intensive treatment of social diseases
present in over 20 per cent of these
patients, many new-born infants are
spared the ravages of congenital dis-ease.
This is bound to result in a re-duction
of penal and institutional care
as these children grow to adolescence
and adult life. "The value of an in-dividual
to the State is more often
than not dependent upon the manner
and the nature of its birth."—Dr.
Cliipmann, Montreal.
The most recent extension of the
scope of this maternal welfare pro-gram
in Mecklenburg County has been
the recent action of the board of
Fehruary, 1937 The Health Bulletin 13
county commissioners who at the re-quest
of Dr. E. K. Hand, county health
officer, have appropriated funds for the
development of prenatal clinics for
charity patients in isolated sections of
the county. These clinics are held in
Huntersville, Pineville, and Steele
Creek on consecutive Wednesdays at 1
p. m. By this means the indigent in
the rural regions will be able to ob-tain
medical services early in their
confinement, and it is hoped that the
maternal and infant mortality rates in
the county will show the same im-provement
that has been obtained in
the city of Charlotte.
If you reduce the activities of the
stork in Mecklenburg County to sta-tistics
you will find that in 1935 ap
proximately 25 per cent and in 1936
approximately 33 per cent of the babies
born were ushered into the world by
Duke Hospital interns under the
supervision of the Kiwanis Club
Charity Maternity Clinic. During the
calender year of 1935 this clinic de-livered
552 Charlotte and Mecklenburg
County babies. This figure will ap-proach
750 births in 1936. This clinitat
was given the highest rating of any!
activity of the City-County Health De-I
partment in a recent appraisal of local!
health activities made by the U. S.I
Public Health Service.
The mortality rate in this clinic is\
far less than that of all births in the
city of Charlotte, and it is one-third
the average mortality rate in the State
of North Carolina. The infant mor-tality
rate of approximately 3 per cent
is remarkable in contrast—te~-the-HP*t
in the best of society. ^In the public
that this clinic serves the incidence of
social diseases, tuberculosis, high blood
pressure and kidney disease, pellagra,
and other deficiency diseases that in-creases
the danger of childbirth to
both mother and infant is much higher
than in the remainder of society.
When the unfortunate environmental
surroundings of this group is consid-ered,
the poverty and social back-ground,
the possibilities of this type of
maternal care when applied univer-sally
over North Carolina and our
other Southern states becomes evident.
Such is the purpose of the maternal
welfare program of the Social Se-curity
Act. This clinic has recently
obtained $1,800.00 yearly through the
Social Security Act.* The Kiwanis
Club of Charlotte gave the first finan-cial
support that made the organiza-tion
of this clinic possible. At the
present time the Kiwanis Club funds
are used for records, certain instru-ments,
emergency medication, ambu-lance
transportation, X-rays, blood
transfusions, and accessory aid of an
emergency nature. An infancy clinic
has recently been established for fur-ther
care of babies delivered by this
service, especially for the further treat-ment
of those born under the handicap
of congenital social disease.
Over 95 per cent_of_these births oc-cur
in homes. Only complicated cases
are hospitalized. Thus the births in
hovels, in tenements, and slums and
in single-room shanties on the banks
of the Catawba, where sanitary condi-tions
range from poor to terrible,
where running water may exist only
when it rains, where the first light to
fall on a new life may be from a kero-sene
wick or a flashlight tucked under
the arm of a young interne and where
the new-born's first bed may be cov-ered
with old newspapers instead of
soft sheets, life is brought into the
world with a high degree of safety and
efficiency. Eight subsequent visits are
made to these homes by visiting nurses,
laboring under the wing of the Good
Fellows Club through the Charlotte
Co-operative Nursing Association.
Awarded through the Department
of Maternal and Child Health Service
of the North Carolina State Board of
Health.
14 The Health Bulletin February, 1937
Three subsequent visits are made by
the physician. Last year student phy-sicians
made 3,500 visits to see pa-tients.
Tliere were 3,217 other visits
to the clinic by expectant mothers.
In conclusion let me add that dur-ing
the past few years a number of
extensive studies on maternity care
have been made, chief of these being
the investigations of the Children's
Bureau of the U. S. Department of
Labor, the Commonwealth Fund, and
the Maternity Center Association of
New York City. Because of the vast
scope of these studies the basic find-ings
are not limited to any one locality
nor to any one group of people. It was
found in general that maternal and in-fant
mortality rate is due to the fact
that many mothers have care which
is inadequate to make maternity safe.
Ignorance was found as one of the
chief causes of the inadequate care.
Ignorance on the part of the expectant
mothers and their families kept some
from seeking good care when it was
available. This ignorance and apathy
of the individual and family is re-flected
in the lack of public interest
and public provision for good maternity
care. The city of Charlotte and Meck-lenburg
County are exceptions to this
finding, for through the medium of this
organization even the more unfor-tunate
women in this community have
been taught the need of medical advice
early in pregnancy. As a result the
vital statistics of 1937 concerned with
maternity and infancy welfare are
those which the citizens of Charlotte
and especially the Kiwanis Club may
well be proud.
Endemic Typhus In North Carolina-
Believed To Be Transmitted By Rat Flea
By Mrs. J. Heney HiGHSMiTH, state Board of Health
THE appearance of thirty or more
cases of typhus fever in North
Carolina during 1936, resulting in
three deaths, is cause for no great
alarm ; however, the severity and fa-tality
of the disease are serious enough
to warrant every precaution being
made to prevent its spread. Especially
is this true now since the question as
to how this disease is carried from
man to man, long a controversial mat-ter,
is believed to have been settled.
Typhus fever is associated in the
minds of most Americans with the
World War, armies, camps, and
trenches. The body louse or "cootie,"
as the doughboys called it, was known
to be the carrier. But the typhus that
is found in North Carolina and other
Southern states today is not the epi-demic
form which was so prevalent
during the World War and which is
still more or less common in many
countries of Europe and other parts of
the world. Neither is it the type that
is associated with slums, filth, and
squalor. It is a more benign type,
less severe in its reactions and having
a low fatality rate. The rate is usu-ally
about 5 per cent or one death In
twenty cases. However, the fatality
varies with age—less than 2 per cent
imder 45 years and about 30 per cent
above 65 years. This disease found in
many of the southeastern states is be-lieved
to have come from Mexico. In
many respects it resembles "Tabar-dillo,"
the Mexican form of typhus.
Both the epidemic and endemic
forms of typhus are said to be caused
by the same germ, the only difference
being a new host and a new means of
transportation for the endemic type.
It is well known that the epidemic
February, 19S7 The Health Bjlletin 16
typhus is borne from man to man by
the body louse, and it is reasonably
certain that the endemic type is borne
from rat to man by the rat flea. The
epidemic typhus is more deadly, shows
a decided preference for cities, espe-cially
crowded slums, and prevails
during the winter and spring. It is
highly communicable. Endemic typhus
shows a preference for rural communi-ties
and has its maximum incidence
during the summer and fall. It does
not spread as rapidly as the epidemic
type and is less fatal.
In both forms, the disease is marked
by a sudden onset with headache, diz-ziness,
and a fever lasting usually
about two weeks. There is always a
rash, a most characteristic symptom,
which appears about the fifth day and
lasts from two to ten days.
According to the July-September re-port
of the Health Section of the
League of Nations, there are four types
of typhus-like diseases in the United
States, these not including the louse
borne type. The endemic benign form
known as Brill's Disease is one of the
group, but it is not to be confused with
the t3T>e found in the South. In re-cent
years numerous studies have been
made of this newer type of typhus
fever in order to find its host and
means of transmission. Kenneth F.
Maxcy, past Assistant Surgeon of the
United States Public Health Service,
was the first to point out that all evi-dence
was against louse transmission
and to suggest that the reservoir might
be the rat. This assumption was later
verified by his co-workers. Dyer,
Badger, Ceder, Kumreich, Workman,
and Kemp. These workers are now
agreed that the disease actually has
its reservoir in rats and that it is
transmitted from rat to rat and occa-sionally
from rat to man by rat fleas.
The question then is, will endemic
typhus, which is flea borne from rats
to man, become in the future as wide-spread
and devastating as epidemic
typhus, louse borne from man to man,
has been in the past? The answer to
this question, it stands to reason, will
depend on the control or lack of con-trol
of rats. To eradicate endemic
typhus it will be necessary to eradicate
rats.
A distressing note concerning ty-phus
fever in the South is that it is
on the increase. "Birmingham's
Health," a bulletin published monthly
by the Jefferson County Board of
Health of Alabama, reports that the
disease began to appear in South Ala-bama
about 1921, and since that time
there have been no less than 2,500
cases of the disease and 102 deaths.
The Bulletin says:
"The highest incidence was in 1933
when 823 cases were reported. In the
first nine months of 1936 266 cases
were reported of which eight occurred
in Jefferson County. Thus the disease
is apparently on the increase in this
territory. While the majority of Ala-bama
cases have been in rural areas,
association with food handling estab-lishments
constitutes an important fac-tor
in urban cases.
"Negroes are relatively free from
the infection, the attack rate being ap-proximately
one-tenth of that of the
white population. Adults are more
often attacked.
"The disquieting fact must be faced
:
typhus has secured a dangerous foot-hold
in certain sections of this State
and each year is spreading northward
in increasing incidence. A broad pro-gram
for the control and eradication
of rats is, therefore, an immediate
public health necessity."
The League of Nations Journal re-cently
issued is also of the opinion
that endemic typhus is on the increase
in the United States. It says:
"It seems that murine typhus (rat
borne) in man has been increasingly
frequent in the United States. In Ala-
16 The Health Bulletin February, 1937
bama, for instance, some 60 to 80 cases
per year have been reported since
Maxcy and Havens discovered it in
1922 througli the Weil-Felix reaction.
It was limited to the cities of the south
and southeastern part of the State.
In 1932 the number of cases rose to
237 (11 deaths) and in 1933 to 823
(35 deaths). The disease had spread
to strictly rural areas without modi-fying
either its mode of spread or its
fatality (Baker, McAlpine & Gill,
1935). In Texas, 417 cases were re-ported
in 1934 against 5 in 1922
(Bohls, 1935). A check in the increase
was, however, obtained as a result of
extensive rat-destruction campaigns in
Texas, Alabama and Georgia."
POISON AND EXPLOSIONS CALSK
MANY HOUSEHOLD ACCIDENTS
Carbon monoxide poisoning, defec-tive
electrical cords, explosions from
cleaning fluids and medicinal poisoning
from administration of the wrong
medicine on the cabinet shelf—all con-tribute
to the high accident toll found
in the home, according to Dr. Louis
L. Lefkowitz who writes of these in
the December Hygeia.
Carbon monoxide poisoning, which
results from the use of illuminating
gas, may be guarded against if the
following points will be observed : 1.
Investigate every odor of gas immedi-ately.
2. Keep all rooms containing
gas fixtures well ventilated at all
times, assuring a good supply of fresh
air. 3. Exercise close supervision of
cooking food so that it will not boil
over and extinguish flame, allowing
free gas to escape. 4. Make certain
that the pilot light is lit or the gas
supply shut off. 5. Where gas heaters
are used see that all connections and
pipes are tight. 6. Before retiring
shut off all gas jets and open the win-dows.
MILK
1. For good health, milk should be
included in the diet of every man,
woman and child. Of all foods, milk is
the outstanding and, in fact, the most
important single food known.
2. Milk improves health. It brings to
our bodies all of the important things
we need for energy and growth, and
when used with vitamin D, found in
sunshine, cod liver oil or viosterol,
helps to make good bones and good
teeth. Milk is our best source of cal-cium,
so necessary for teeth and bones.
3. Milk should not be limited to in-fants,
who thrive on it. It is also an
essential food for the growing child.
It is an essential food for adults, too.
It is imperative that pregnant and
nursing mothers have milk if babies
are to develop and thrive as they
should.
4. The recommendation of nutrition
and health authorities that more milk
be used should be given serious con-sideration
by all parents. If this ad-vice
is followed, growing children will
receive the amount of milk necessary
for good health and strong bodies.
5. All children should have a quart
of milk every day, and adults at least
one pint. Use milk freely—as a drink,,
hot or cold, plain or flavored; with
puddings, cereals, cream soups ; or as
ice cream.
6. Compared with other foods of
similar values, milk is the cheapest;
never "stint" with milk.
7. Remember
:
Tour child needs milk for his healtb
and growth.
You need it to keep your health.
Don't deprive yourself and your fam-ily
of the most nearly perfect food.
There is no substitute for milk!
—
Agricultural Review.
nrr ^%d
This Dullelirvwillbe 3er\1 free to qtmj ci-hzen of the Stole upor\rec[ue5t |
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894,
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 52 MARCH, 1937 No. 3
E. R. HARDIN, M.D., LUIVIBERTON, N. C.
For the Past Sixteen Years Health OflScer of Robeson County
Above is a photograph of Dr. Hardin, who recently began his seventeenth year
as full time health officer of Robeson County. He enjoys the distinction of prob-ably
being the only health officer in North Carolina to have the question of
continuance of his department work submitted to a vote of the people. A few
years ago a Robeson legislator put such an act through the Legislature. The
election resulted in an eight to one popular vote in favor of Dr. Hardin and
his department work.
He has rendered a valuable service to the people of Robeson County, par-ticularly
in his work for mothers and babies among the poor.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. Craig, M.D., President _ „ _ Winston-Salem
J. N. Johnson, D.D.S.. Vice-President _ Goldaboro
G. G. Dixon, M.D - Ayden
H. Leb Large, M.D _ _ Rocky Mount
H. G. Baity, ScD _ _ _Chapel HiU
W. T. Rainey, M.D Fayettevitle
HUBBRT B. Haywood, M.D „ - Raleigh
Jambs P. Stowb, Ph.G _ —• Charlotte
J. LaBruce Ward. M.D - _ - ^.Aaheville
Executive Staff
Carl V. Reynolds, M.D., Secretary and State Health Officer.
G. M. CooPEiR, M.D., Assistant State Health Officer and Director Division
of Health Education. Crippled Children's Work, and Maternal
and Child Health Service.
Warren H. Booker, C.E.. Director Division of Sanitary Engineering
and Malaria Control.
Ernest A. Branch, D.D.S., Director Division of Oral Hygiene.
John H. Hamilton, M.D., Director Division of Laboratories.
J. C. Knox, M.D., Director Division of Epidemiology and Venereal
Disease Control.
R. T. Stimson, M.D., Director Division of Vital Statistics.
R. E. Fox, M.D., Director Division of County Health Work.
H. F. Easom, M.D., Director Division Industrial Hygiene.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly
which will be sent free to any citizen requesting
available for distribution without charge special
lug subjects. Ask for any in which you may be
Adenoids and Tonsils
Cancer
Constipation
Chickenpox
Diabetes
Diphtheria
Don't Spit Placards
Eyes
Flies
Fly Placards
German Measles
Health Education
Hookworm Disease
Infantile Paralysis
Influenza
Malaria
Measles
Pellagra
Residential Sewage
Disposal Plants
Sanitary Privies
The Health Buixetin,
it. The Board also has
literature on the foUow-interested.
Scarlet Fever
Smallpox
Teeth
Tuberculosis
Tuberculosis Placards
Typhoid Fever
Typhoid Placards
Venereal Diseases
Water Supplies
Whooping Cough
SPECIAL LITERATURE ON
The following special literature on
free to any citizen of the State on r
Raleigh, N. C.
Prenatal Care (by Mrs. Max West)
Prenatal Letters (series of nine
monthly letters
)
Minimum Standards of Prenatal Care
Breast Feeding
Infant Care. The Prevention of
Infantile Diarrhea
Table of Heights and Weights
MATERNITY AND INFANCY
the subjects listed below will be sent
equest to the State Board of Health,
Baby's Daily Time Cards : Under 5 monthi
;
5 to 6 months ; 7, 8, and 9 months ; 10
11, and 12 months : 1 year to 19 months
19 months to 2 years.
Diet List: 9 to 12 months ; 12 to 15
months ; 16 to 24 months ; 2 to 8
years ; 3 to 6 years.
Instructions for North Carolina Midwives.
CONTENTS
Pags
Notes and Comment 8
Prenatal Clinics in Raleigh 5
N. C. Bureau of Vital Statistics—Provisional Report for 1936 _ _. 6
Facts Concerning Self-Medication 6
Vital Statistics Records 7
Results Obtained in Prenatal Clinics at Rex Hospital and St. Agnes Hospital in Raleigh 9
Acne in Young People—Its Cause and Treatment 11
National Negro Health Week Observance _ 18
Wives of State Officials Propose Syphilis Tests for Domestic Servants 15
Total Number Births and Deaths Under One Year of Age (Exclusive of Stillbirths) in
Each County with Rates per 1.000 Live Births: 1935 16
I PUBLI5ME.D BY TMEL noR.TA CAgQUMA 5TATL BOAgD "XMLALTM |
Vol. 52 MARCH, 1937 No. S
Notes and Comment
By The Editob
MARCH is the month of the year
when the lengthening days and
the increased hours of sunshine
make outdoor life more pleasant and
therefore begin to dispell the colds and
sniffles of winter. It begins to bring
the color back to the babies' cheeks and
relieves the mothers of much nervous
strain in caring for their little ones
kept inside the house for so many
weeks.
There is one aspect, however, that
such change in conditions and living
habits bring about which is not so
pleasant, but is disturbing. It is the
traditional habit, more a habit of
mind, of dosing the entire family with
laxatives and purgatives and what-nots.
It is the golden period for the
sellers of so-called "tonics" and "re-juvenators"
and "blood builders," etc.
In the old days, the molasses and sul-phur
habit followed by the very pleas-ant
custom of several weeks indul-gence
in sassafras tea was not nearly
so bad as the present methods of de-pending
on the various "patent" medi-cines
advertised so promiscuously in
almost every newspaper and over
nearly all the radio stations.
The matter of regulating one's way
of living, that is, the personal hygiene
we might call it, is a matter for each
individual to decide for himself.
Every one should partake of some
essential foods known as protective
foods in the diet daily. Such foods
comprise vegetables, fruits, some meats,
and plenty of milk and dairy products.
The foregoing are known as protective
foods, and some of them are essential
for good health for everybody.
The vitamin racket as practiced to-day
is probably one of the worst in the
realm of food which the country has
ever experienced. Knowledge of foods
has been wonderfully increased by the
discovery and scientific study of vita-mins,
but the trouble is half truths
have been seized upon by commercial
interests and the people are being ex-ploited
world without end. They are
being urged to spend their money for
this, that, and the other as containing
the necessary vitamins, without which
the prospective patron would immedi-ately
die, and one of the troubles is
that people are urged that such essen-tial
elements in the food or medicine
could nowhere else be obtained except
in this particular product right then
being advertised. The old custom still
stands as the best possible advice for
people to follow, and that is a balanced
diet comprising some of the essential
foods in every day's diet.
The question of self-medication has
become one of the most serious that
people have to contend with, owing
to the intensive advertising carried on
today by a few unscrupulous dealers
in remedies which are far from safe.
The Health Bulletin March, 1957
In this connection, we want to call at-tention
to an article in this issue by
Dr. S. V. Lewis, Assistant Health Offi-cer
of the Orange-Person District
Health Department at Roxboro. The
title of the article is "Facts Concern-ing
Self-Medication." The reader will
find Dr. Lewis' article very interest-ing.
Dr. Lewis very properly empha-sizes
the most essential requirement
which must be established before any
medication of any kind is taken by
any human being, and that is a diag-nosis
must be made first. This is one
of the hardest things that a physician
has to do. It is certainly more rea-sonable
to believe that a physician who
has had long years of experience in
study and treatment of disease is more
capable of making a diagnosis than
one who has never given the matter a
thought except when he might have
an ache or pain. The Sairey Gamps
and the fishwives have been with the
world since time immemorial. The
radio announcers with a pleasant
voice who daily send out over the air
accounts of the wonders of certain
medicines and the cocksure newspaper
advertisers who daily publish the so-called
virtues of the various remedies
advertised to satisfy the desires for
self-medication are nothing more nor
less than polished, educated Sairey
Gamps and fishwives. There is one
vital difference, however, and that is
that the Sairey Gamps and the fish-wives
of tradition have always given
their advice free and without price,
and with no other motive than that
they just simply love to tell other
folks what to do and to pose as the
possessors of wisdom the average hu-man
does not have, but the Sairey
Gamps and the fishwives of today in
their advertisements over the radio
and in the newspapers are carrying
on the fishwives' traditions for the
money there is in it.
Once again we offer the free advice
here that when medication of any kind
is needed, the best policy to pursue is
to let a competent physician prescribe
what is to be taken.
fT^ HE newspapers some weeks ago
carried a most gratifying item sent
out from Detroit, Michigan. We re-fer
to the dispatches describing the
roundup by Federal police agents of
a group of ten or twelve eye "doctor"
fakers who have been operating for
many years all over the country. We
have been mentioning from time to
time in these columns the activities
of these fakers in North Carolina. We
have urged people everywhere to re-fuse
to have dealings of any kind with
these traveling frauds and robbers.
Notwithstanding all our urgent warn-ings
and warnings of many other peo-ple
in the State by newspaper publicity
during the last fifteen years, we feel
sure that these fakers have defrauded
people in North Carolina of hundreds
of thousands of dollars of hard-earned
money. The newspapers did
not follow through with the outcome
of the trial. As Michigan does not
have a capital offense law and there-fore
they cannot be hung in that state,
the best that we hope for is a life im-prisonment.
That would be getting off
entirely too easy, but it is the best
that could be expected. In any event,
we hope they have them all.
It will be remembered that some
years ago two of the most active were
arrested by a deputy sheriff up in
Forsyth County. They were released
on a $2,000 bond, which they promptly
forfeited and were never heard of
again. We fear, however, that the
racket was so successful and so pro-ductive
of big money that the Federal
agents have not rounded them all up.
It would, therefore, be wise for our
readers to decline to do business with
March, 1937 The Health Bulletin
any kind of an agent who comes to
one's home with the proposition to
talk about eye diseases or to sell medi-cines
of any kind. We still insist that
if at any time in the future one of
these traveling eyeglass fakers comes
to one's home, the best plan to follow
would be to detain them long enough
for the police or the sheriff to be
called and have an arrest made at
once. Id * *
TpOR several years pediatricians have
insisted that a daily ration of cod
liver oil should be given to every new-born
baby until it is about eighteen
months of age. This should be given
every day as a precaution against the
nutritional disturbances which would
eventually have such disastrous re-sults
on the babies' teeth formation
and the bony system of the body. Such
deficiencies frequently are evidenced
in such diseases as rickets.
The nurses working for the State
Board of Health have always been
urged to advise the parents of babies
to carry out this policy, especially in
cases where the babies show evidence
of nutritional deficiencies. One of our
nurses recently reported that some
manufacturing concern selling cod liver
oil had given her a large supply to
give out as samples. A druggist
friend of hers divided the samples in
2-ounce bottles and she presented it
to some mothers of babies who were
specially in need of this vital element
in their diet with such satisfactory
results that the druggist reported later
a very large return of the sample bot-tles
for more of the stuff to be pur-chased
direct. They were convinced
of the improvement in the babies' con-dition
in a short time.
We call attention to this in the hope
that the habit will be more generally
followed in remote sections where the
babies so urgently need such care.
Prenatal Clinics In Raleigh
In our February issue we published
an article by Dr. W. Z. Bradford of
Charlotte, the title of which was
"Maternal and Child Health Work in
Charlotte, N. C." On reading this
article a group of physicians here in
Raleigh who have been doing con-siderable
work along the same lines
described by Dr. Bradford were very
much interested in the Bradford
article, and all of us feel that our
readers will be much interested in
knowing of the progress being made
along this line by this group of Raleigh
physicians. We requested Dr. Verne
S. Caviness of Raleigh, who was fa-miliar
with the work, to write a brief
description of what has been done
here. This article by Dr. Caviness
will be found in this issue.
Just a few years ago about one-third
of the deliveries of babies in
the city of Raleigh were by midwives.
Of course the majority of them were
Negroes, but there were many white
women dependent on midwives. Every-body
will be interested in the state-ment
Dr. Caviness makes that no
white woman in Raleigh has been at-tended
by a midwife in more than a
year. Another rather amazing state-ment
is that in the eight years that
this work has been under way there
has not been a death of any mother
who regularly visited the prenatal
clinics. It must be understood, of
course, that these clinics are strictly
for indigent women.
The description of the work here,
following the article describing the
work in Charlotte, is evidence of prog-ress
now being made in various parts
of the State which will eventually lead
to a material reduction in the maternal
and infant death rate in North Caro-lina.
The Health Bulletin March, 19S7
NORTH CAROLINA BUREAU OF VTTAX. STATISTICS
PROVISIONAL. REPORT FOR 1936
1935
Total number deaths... 85,834 83,451
Death rate 10.4 9.8
Total number births.... 76.869 79,596
Birth rate 22.2 23.3
Infant deaths (under
one year) _ 5,184 6,407
•Infant mortality rate 67.4 67.9
Maternal deaths 499 664
Maternal mortality rate 6.6 7.0
No. Rate No. Rata
Typhoid and para-typhoid
fever 76
Endemic typhus fever 8
Undulant fever 3
Smallpox
Measles 9
Scarlet fever 25
Whooping cough 35
Diphtheria _ 190
Influenza 1114
Acute poliomyelitis
and polioencephalitis 12
Epidemic cerebrospinal
meningitis _ 54
Rabies 5
Tetanus 29
Tuberculosis, pulmo-nary
1896
Tuberculosis, other
forms 200
Syphilis, locomotor
ataxia, paresis 406
2.2
0.09
0.09
0.3
0.7
1.0
5.5
32.2
0.3
1.6
0.1
0.8
1
69
22
308
168
1033
2.4
O.OS
2.0
0.6
9.0
4.9
80.2
72 2.1
38
6
24
1.1
0.2
0.7
64.8 1761 61.5
5.8 175 6.1
11.7 408 11.8
No.
Malaria _ 150
Cancer, all forms _1789
Diabetes mellitus 400
Pellagra 849
Pneumonia, all forms. .3480
Diarrhea and enteritis
(under 2 years) 812
Appendicitis 818
•Puerperal septicemia.. 115
•Puerperal, other forms 384
Suicide 282
Homicide 864
PREVENTABLE ACCIDENTS
Rate
March, 1937 The Health Bulletin
treated, and then is able to prescribe
such drugs as may produce the desired
results; otherwise, if drugs are admin-istered,
they may produce undesired or
even dangerous results.
The pure food and drug act pro-hibits
the sale of preparations adver-tised
to cure tuberculosis, caucer, and
other malignant diseases. All prepara-tions
must contain ingredients as ad-vertised
on the package, but the medi-cine
manufacturer is not required to
label his concoctions unless they con-tain
poisonous drugs such as acetana-lid,
strychnine and some others, and
only rarely does the purchaser realize
the significance of such drugs as are
mentioned on the label and their dan-gerous
character. Since so many
highly advertised patent remedies con-tain
poisonous drugs, the only safe
policy is to secure a physician's advice
regarding a preparation before inflict-ing
it on the system.
A close observation of avertising
propaganda will reveal that the various
remedies flaunted before us from maga-zines,
newspapers or billboards, and
over the radio are usually not adver-tised
as cures for diseases, but as re-lief
for certain symptoms. However,
the advertisements are frequently so
cleverly worded that the very decided
suggestion is received that they are
cures.
I do not deny that some of the prep-arations
used in self-medication could
be of some benefit if we knew two
very imjwrtant facts. First, if we
knew what disease or condition web
present. Second, if we knew what
drugs or substances were in the prep-aration,
something that is not usually
known unless the preparation contains
some of the poisonous drugs that must
be labeled in order to comply with the
law. Thus, self-medication with patent
medicines is really the treatment of a
condition whose nature is not known
with a remedy regarding the real ef-fects
and dangers of which we are
totally ignorant. Hardly a very in-telligent
procedure, is it?
When advised to take this or that
for acid indigestion, why and how do
we know our symptoms are not due to
stomach ulcers or cancer of the stom-ach?
It is not justice to ourselves to
take some preparation advertised to
establish the alkaline balance, when
there may be some malignant disease
causing the disturbance, if indeed our
trouble is in any way connected vrtth
the alkaline balance. Remedies con-taining
poisonous drugs are advertised
for the relief of inorganic pains, but
the advertisements do not tell that
death may occur if the remedy is taken
by one having an organic heart dis-ease.
The most of us may not be expected
to look for the things omitted in medi-cine
advertising, but for the safety of
ourselves and our families, we can re-frain
from self-medication and go to a
physician with our ills. He is the only
one competent to diagnose and treat
them.
Vital Statistics Records
IN this issue we are publishing two
sets of vital statistics figures
which should be interesting to all
our readers. The first item we will
mention is a comparison between the
records for 1935 and those for 1936.
These tables will be found elsewhere
in this issue. In one of the tables we
are presenting such information as the
total number of deaths and births oc-curring
in the State in 1935 and 1936.
The 1935 figures are final, that is,
they are what we call adjusted fig-ures.
The items for 1936 are what
8 The Health Bulletin March, 19S7
is called provisional, that Is, they will
be subject to slight changes later on.
It will be noted that the birth rate
was approximately one point lower in
1936 than it was the previous year,
there being nearly 3,000 fewer births
last year than there were the year
before. It will be noted also that the
number of deaths of infants under one
year of age last year was fewer, but
there was not a sufficient decrease to
materially change the rate, although
it was reduced half a point.
The maternal mortality was a little
lower last year than the previous year.
It is gratifying to point out that ty-phoid
fever continued its steady de-cline,
reaching the lowest rate in the
history of the State. The rate on
diphtheria, however, was increased.
Deaths from influenza in each of the
two years ran considerably over 1,000.
the rate being higher last year than
the year before. The deaths from in-fantile
paralysis reached almost to a
subnormal level, which was quite a
contrast to the rate of the preceding
year.
One of the most disturbing aspects
in this report is that there were eleven
deaths in the two years from rabies,
six in 1935 and five last year. All
these deaths were diagnosed as hydro-phobia
beyond any question of doubt.
All of them were tragic, and the de-scriptions
in the Leaksville and
Reidsville papers of one of these
deaths which occurred in Rockingham
County were classics. These news-papers
described the death in that
county as being terrifying in every
particular. There is no excuse for
any human being in this State to die
from rabies, as a few simple restric-tions
of state-wide character could be
enforced in the control of dogs. All of
us note every day in our journeys
here and there flocks of dogs, large
and small, vicious and otherwise,
roaming at large on the streets and
in the roads, mingling with children,
none of them muzzled or under con-trol
of their masters. It is a disgrace-ful
situation.
It will be noted that there was a
slight increase in the number and rate
in deaths from tuberculosis. Deaths
from syphilis remained about the
same. Malaria caused 150 deaths last
year as compared to 94 the preceding
year. There was a reduction in the
deaths from pellagra, although 349
people died last year from that dis-ease.
Pneumonia again led the pro-cession
as the